Abstract
Introduction: Biliary tract tumors, or cholangiocarcinomas (CCAs), comprise a heterogeneous group of malignant tumors that can affect any part of the biliary tree, from the interlobular canals of Hering to the primary biliary duct. In the last 20-30 years, the incidence of these tumours has increased especially after the introduction of the new imaging techniques endoscopic retrograde cholangiopancreatography (ERCP, percutaneous transhepatic cholangiography) and the increased interest for this pathology.
Objective: To evaluate the diagnostic methods and therapeutical results in patients with extrahepatic bile duct cancer.
Material and Method: This cross-sectional study was conducted in the , Department of Surgery, Mymensingh Medical College Hospital, Mymensingh, Bangladesh from Jun-2018 to July-2021. We included 124 consecutive patients with suspected bile duct cancer who underwent endoscopic retrograde cholangiopancreatography (ERCP). Every patient underwent an ultrasound (US) examination before ERCP. ERCP was considered as the “gold standard” for diagnosis. The therapy applied consisted of endoscopic stenting, US guided biliary drainage or surgery. The sensitivity, specificity and accuracy were calculated for every tumour localisation and also globally for all tumours.
Results. The sensitivity, specificity and accuracy of US were 85.9%, 76.9% and 84.4% for hilar localization, 59.1%, 50% and 57.1% for the mid common bile duct (CBD) and 33.3%, 42.8% and 36.8% for the distal CBD tumours. The global performances for US in diagnosing extrahepatic chlonagiocarcinoma were 73.5%, 61.5% and 70.9%. In 73 cases (74.5%) an endoscopic stent was placed. In 11 cases (11.2%) we performed an US guided biliary drainage and in 14 cases (14.2%) surgery was recommended.
Conclusion: Ultrasonography proved to be a reliable method for the diagnosis of bile duct cancer in spite of its low accuracy for distal localization. The combination of the two investigations (US and ERCP) was very efficient in the management of these patients. Endoscopic stenting for hilar localization is a good therapeutical option.