BILE-DUCT CARCINOMA WITHOUT JAUNDICE - CLUES TO EARLY DIAGNOSIS

Background/Aims: Most bile duct carcinomas are diagnosed at an, advanc ed stage, after the appearance of jaundice. The features of bile duct carcinomas without jaundice were analyzed with the aim of allowing ear ly diagnosis in such cases. Methodology: Clinicopathological features, images and surgical outcomes were compared between 18 non-jaundiced a nd 85 jaundiced patients with extrahepatic bile duct carcinoma. Result s: Among the non-jaundiced patients, 13 were symptomatic. Abnormalitie s on, hepatic function and tumor marker tests were seen in. 56% and 44 %, respectively. In all 18 cases, ultrasonography demonstrated biliary abnormalities including masses (9 patients) and strictures (5 patient s). The diagnosis was confirmed histologically by transpapillary bile duct biopsy in. eight of 10 nonjaundiced patients. The nonjaundiced pa tients (83%) had a higher rate of resectability than jaundiced patient s (58%), Pathological findings of resected specimens showed no signifi cant differences between the two groups. The non-jaundiced group had a significantly higher survival rate than the jaundiced group: 50% vs. 22% at 5 years. Conclusion: For early diagnosis of bile duct carcinoma s not associated with jaundice, detailed ultrasonographic examination is useful, and subtle changes indicate a need for direct cholangiograh y. Non-jaundiced cases have the potential for curative resection.