Endoscopic retrograde cholangiography in the diagnosis and treatment of mucobilia.
OBJECTIVE
Some biliary neoplasms secrete copious mucin into bile ducts, yet the management of mucobilia is not well known. The objective of this study was to analyze 16 patients with copious mucin in the biliary tract stressing the diagnostic and therapeutic aspects of endoscopic retrograde cholangiography (ERC).


METHODS
Sixteen patients with mucobilia were found among 5635 cases of ERC from October 1999 to October 2006 in our institution. Diagnostic and therapeutic ERC as well as clinical features were retrospectively analyzed.


RESULTS
Mucin had a greater impact than the neoplasm itself on the cholangiogram and clinical presentation. ERC failed to show the tumors but a disproportionate or aneurysmal dilatation of the segmental or lobar duct correlated with the tumor-bearing duct was evident. Endoscopic managements included clearance of intraductal mucin and/or endoscopic nasobiliary drainage (ENBD). Three patients were excluded from outcome assessment because of non-specific symptoms or spontaneously subsiding jaundice. Among the 13 patients eligible for assessment, subjective improvement in symptoms and/or a decrease in jaundice along with subsiding cholangitis following ERC was observed in 5 of the 7 patients that underwent both clearance of intraductal mucin and ENBD (ENBD function was poor in all 7 patients), in 1 patient who underwent only clearance of intraductal mucin, and in 3 of the 5 patients who underwent only ENBD. The three patients with progressive jaundice, despite endoscopic management, had advanced disease.


CONCLUSIONS
ERC revealed the tumor-bearing duct but not the extent of the disease in most of the patients with mucobilia. When mucobilia is encountered during ERC, the management should include clearance of as much intraductal mucin as possible. ENBD is frequently obstructed by mucin and may be helpful only in selected cases.
Tsou
Yung-Kuan
YK
Departments of Hepato-Gastroenterology, Pathology, Chang Gung Memorial Hospital & Chang Gung University College of Medicine, Taipei, Taiwan.
Liu
Nai-Jen
NJ
Wu
Ren-Chin
RC
Lee
Ching-Song
CS
Tang
Jui-Hsiang
JH
Hung
Chien-Fu
CF
Jan
Yi-Yin
YY
D002288:Adenocarcinoma, Mucinous / Q000175:diagnosis* / Q000378:metabolism* / Q000473:pathology / Q000601:surgery; D000231:Adenocarcinoma, Papillary / Q000175:diagnosis* / Q000378:metabolism* / Q000469:parasitology / Q000601:surgery; D000368:Aged; D001650:Bile Duct Neoplasms / Q000175:diagnosis* / Q000378:metabolism* / Q000473:pathology / Q000601:surgery; D001653:Bile Ducts, Intrahepatic / Q000378:metabolism; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000379:methods; D015331:Cohort Studies; D004322:Drainage / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009077:Mucins / Q000032:analysis / Q000378:metabolism*; D012189:Retrospective Studies; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D016896:Treatment Outcome
D009077:Mucins