ARE SECONDARY BILE-ACIDS IN CHOLEDOCHAL CYSTS IMPORTANT AS A RISK FACTOR IN BILIARY-TRACT CARCINOMA

Since secondary bile acids have mutagenic potency and choledochal cyst patients with or without cystenterostomy have a high risk of developi ng bile duct carcinoma, we examined the hypothesis that secondary bile acids are elevated in the choledochal cyst and possibly cause biliary tract carcinoma. Eleven choledochal cyst patients with or without pre vious cyst-enterostomy or biliary tract carcinoma, seven patients with biliary tract carcinoma not associated with choledochal cyst and five patients with cholecystolithiasis were examined. Samples were directl y needle aspirated from the cyst or by cannulating a tube into the com mon bile duct through the cystic duct. The concentrations of each bile acid in these samples were quantified by gas-liquid chromatography an d compared. Neither the relative composition nor the absolute concentr ation of secondary bile acids (deoxycholic acid, lithocholic acid) ele vated in patients with choledochal cyst compared with the values in th e non-choledochal cyst patients with or without biliary tract carcinom a. The presence of biliary tract carcinoma or previous cyst-enterostom y did not affect the concentrations of secondary bile acids. The resul ts suggest that the factor other than secondary bile acids can be prim arily responsible for the high risk of bile duct carcinoma in patients with choledochal cyst.