1988 Volume 30 Issue 6 Pages 1175-1182_1
From 1977 through 1985, 227 patient were examined by PTCS. Fifty patient with distal bile duct stenosis were picked up and PTCS findings were studied. PTCS findings were classified as redness, intra-biliary protrusion (granular, papillary, nodular protrusion on the bile duct wall), tumor vessels (small vessels running tortuously, diameter not uniform), distortion (bile duct distorted) and extra-biliary compression (bile duct wall is compressed from the outside). In bile duct carcinoma and papilla Varter carcinoma, redness, nodular or papillary protrusions, tumor vessels were observed at the stenotic part of the bile duct by PTCS in all cases but distortion, extra-biliary compression were not observed and diagnosed histologically by cholangioscopic biopsies in all cases. In pancreatic carcinoma, redness, intra-biliary protrusion and tumor vessels were observed in 93%, 71%, 68% and distortion, extra-biliary compression were also observed in 68%, 96% at the stenotic part of the bile duct. Cancer was positive in endoscopic biopsies in 79%. In chronic pancreatitis, intra-biliary protrusion, tumor vessels were not observed but redness, distortion and extra-biliary compression were observed at the stenotic part of the bile duct in all cases. In benign stricture of the bile duct, redness, nodular protrusion were seen but tumor vessels, distortion and extra-biliary compression were not observed at the stenotic part of the bile duct. From these findings, we can conclude that tumor vessels are those of carcinoma, and distortion and extra-biliary compression are findings of pancreatic lesion influencing the bile duct. So we can make the differential diagnosis of bile duct carcinoma (papilla Vater carcinoma) from benign stricture of the bile duct by the PTCS findings of tumor vessels observed or not and from pancreas lesion by the findings of distortion and extra-biliary compression not observed or observed. A pancreatic lesion is able to divide pancreas carcinoma from pancreatitis by the findings of tumor vessels observed or not. The differential diagnosis of pancreatic carcinoma from pancreatitis is difficult even by using PTCS, if the bile duct stenosis can not be seen by the endoscope for the bile duct too much distorted or compressed from the outside and/or if pancreatic carcinoma does not invade the bile duct.
