title: Endoscopic diagnosis of intraductal papillary mucinous neoplasm of the bile duct.
abstract: OBJECTIVE
  Intraductal papillary mucinous neoplasm of the bile duct (IPMN-B) is considered an uncommon tumor. The purpose of this study was to evaluate the diagnostic utility of endoscopic cholangiography (ERC) with subsequent peroral cholangioscopy (POCS) and/or intraductal ultrasonography (IDUS) for this tumor.
  
  
  METHODS
  From December 1991 to November 2006, a retrospective analysis was made of eight patients with IPMN-B. Their clinical features and the endoscopic diagnostic strategy for POCS and IDUS were reviewed.
  
  
  RESULTS
  In all the patients, ERC failed to show papillary tumors, due to coexisting mucin or biliary sludge. POCS was carried out after ERC and it showed the presence and locations of papillary tumors in all patients, except for one with a tumor in the peripheral intrahepatic bile duct (B3). IDUS was performed in seven of the eight patients; in five of these patients, intraductal protruding tumors were clearly visualized, whereas flat tumors were not identified in the remaining two patients. In one of the eight patients, endoscopic nasobiliary drainage did not remove the huge amount of mucin. Hence, this patient required subsequent percutaneous biliary drainage. Six of the eight patients underwent surgical treatment; five patients underwent a hepatic resection with or without extrahepatic bile duct resection and one underwent a pancreaticoduodenectomy. Five of the six operated patients are still alive; one patient died of gastric cancer 90 months after the operation (mean follow-up period, 45.3 months). The two remaining patients, who were considered inoperable due to major medical comorbidities, died of liver failure and cholangitis 3 and 6 months, respectively, after stent placement.
  
  
  CONCLUSIONS
  ERC failed to delineate intraductal papillary tumors, due to coexisting mucin. The presence and location of papillary tumors were correctly diagnosed by both POCS and IDUS, but POCS may be better than IDUS to diagnose the extent of the tumor.
authors: Department of Medicine and Clinical Oncology, Graduate School of Medicine, Chiba University, Inohana 1-8-1, Chuou-ku, Chiba, 260-8670, Japan, tsuyuguchi@faculty.chiba-u.jp.
authors: Toshio
authors: T
authors: Tsuyuguchi
authors: Yuji
authors: Y
authors: Sakai
authors: Harutoshi
authors: H
authors: Sugiyama
authors: Kaoru
authors: K
authors: Miyakawa
authors: Takeshi
authors: T
authors: Ishihara
authors: Masayuki
authors: M
authors: Ohtsuka
authors: Masaru
authors: M
authors: Miyazaki
authors: Osamu
authors: O
authors: Yokosuka
mesh_terms: D002288:Adenocarcinoma, Mucinous / Q000175:diagnosis*; D000231:Adenocarcinoma, Papillary / Q000473:pathology*; D000368:Aged; D000369:Aged, 80 and over; D001650:Bile Duct Neoplasms / Q000175:diagnosis* / Q000473:pathology; D017734:Bile Ducts, Extrahepatic / Q000473:pathology; D001653:Bile Ducts, Intrahepatic / Q000473:pathology; D002760:Cholangiopancreatography, Endoscopic Retrograde; D016099:Endoscopy, Gastrointestinal; D019160:Endosonography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies