title: Flowcharts for the management of biliary tract and ampullary carcinomas.
abstract: No strategies for the diagnosis and treatment of biliary tract carcinoma have been clearly described. We developed flowcharts for the diagnosis and treatment of biliary tract carcinoma on the basis of the best clinical evidence. Risk factors for bile duct carcinoma are a dilated type of pancreaticobiliary maljunction (PBM) and primary sclerosing cholangitis. A nondilated type of PBM is a risk factor for gallbladder carcinoma. Symptoms that may indicate biliary tract carcinoma are jaundice and pain in the upper right area of the abdomen. The first step of diagnosis is to carry out blood biochemistry tests and ultrasonography (US) of the abdomen. The second step of diagnosis is to find the local extension of the carcinoma by means of computed tomography (CT), magnetic resonance imaging (MRI), magnetic resonance cholangiopancreatography (MRCP), percutaneous transhepatic cholangiography (PTC), and endoscopic retrograde cholangiopancreatography (ERCP). Because resection is the only way to completely cure biliary tract carcinoma, the indications for resection are determined first. In patients with resectable disease, the indications for biliary drainage or portal vein embolization (PVE) are checked. In those with nonresectable disease, biliary stenting, chemotherapy, radiotherapy, and/or best supportive care is selected.
authors.affiliation: Department of Gastroenterological Surgery, Fujita Health University, Kutsukake-cho, Toyoake, Aichi, Japan.
authors.forename: Shuichi
authors.initials: S
authors.lastname: Miyakawa
authors.forename: Shin
authors.initials: S
authors.lastname: Ishihara
authors.forename: Tadahiro
authors.initials: T
authors.lastname: Takada
authors.forename: Masaru
authors.initials: M
authors.lastname: Miyazaki
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Tsukada
authors.forename: Masato
authors.initials: M
authors.lastname: Nagino
authors.forename: Satoshi
authors.initials: S
authors.lastname: Kondo
authors.forename: Junji
authors.initials: J
authors.lastname: Furuse
authors.forename: Hiroya
authors.initials: H
authors.lastname: Saito
authors.forename: Toshio
authors.initials: T
authors.lastname: Tsuyuguchi
authors.forename: Fumio
authors.initials: F
authors.lastname: Kimura
authors.forename: Hideyuki
authors.initials: H
authors.lastname: Yoshitomi
authors.forename: Satoshi
authors.initials: S
authors.lastname: Nozawa
authors.forename: Masahiro
authors.initials: M
authors.lastname: Yoshida
authors.forename: Keita
authors.initials: K
authors.lastname: Wada
authors.forename: Hodaka
authors.initials: H
authors.lastname: Amano
authors.forename: Fumihiko
authors.initials: F
authors.lastname: Miura
mesh_terms: D000465:Algorithms; D014670:Ampulla of Vater; D001661:Biliary Tract Neoplasms / Q000175:diagnosis / Q000628:therapy; D002277:Carcinoma / Q000175:diagnosis / Q000628:therapy; D006801:Humans; D012307:Risk Factors