Biliary papillomatosis: Clinical, cholangiographic and cholangioscopic findings

Background and Study Aims: Biliary papillomatosis (BP) is a very rare disea se and its clinical features and outcome are not well known, The aims of th is study were to describe the characteristic cholangiographic findings and to define the role of cholangioscopic examination in the diagnosis and trea tment of this disorder. Patients and Methods: Nine patients (six men and three women, mean age 57 y ears) were diagnosed as BP among 5361 cases of endoscopic retrograde cholan giography (ERC) from 1990 to 1997 in our institution. The cholangiographic and cholangioscopic findings as well as clinical features were retrospectiv ely analyzed. Results: ERC findings showed multiple small, round-to-ovoid filling defects in the bile duct and ductal wall irregularity in all the patients. Seven o ut of nine patients underwent percutaneous transhepatic cholangioscopic (PT C) examination. Additional small papillary lesions in the intrahepatic bile duct were detected by cholangioscopic examination in four patients whose E RC findings only revealed the extrahepatic lesions. Two of these four patie nts underwent curative resection, In these two patients, the initial surgic al plan was changed from Whipple's operation to hepatico-pancratico-duodene ctomy after preoperative cholangioscopic examination due to the detection o f new lesions in the intrahepatic bile duct. Conclusions: ERC findings of BP were highly characteristic. When BP is susp ected by conventional imaging including ERC, preoperative percutaneous tran shepatic cholangioscopic examination is, however, strongly recommended. Thi s procedure may be beneficial to precisely determine the ductal extension o f the disease, hence to decide whether or not hepatic resection is needed a s well as to confirm the histology.