Abstract
Background and Study Aims: Biliary papillomatosis (BP) is a very rare disease and its clinical features and
outcome are not well known. The aims of this study were to describe the characteristic
cholangiographic findings and to define the role of cholangioscopic examination in
the diagnosis and treatment of this disorder.
Patients and Methods: Nine patients (six men and three women, mean age 57 years) were diagnosed as BP among
5361 cases of endoscopic retrograde cholangiography (ERC) from 1990 to 1997 in our
institution. The cholangiographic and cholangioscopic findings as well as clinical
features were retrospectively 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 out of nine patients underwent
percutaneous transhepatic cholangioscopic (PTC) examination. Additional small papillary
lesions in the intrahepatic bile duct were detected by cholangioscopic examination
in four patients whose ERC findings only revealed the extrahepatic lesions. Two of
these four patients underwent curative resection. In these two patients, the initial
surgical plan was changed from Whipple's operation to hepatico-pancratico-duo-denectomy
after preoperative cholangioscopic examination due to the detection of new lesions
in the intrahepatic bile duct.
Conclusions: ERC findings of BP were highly characteristic. When BP is suspected by conventional
imaging including ERC, preoperative percutaneous transhepatic cholangioscopic examination
is, however, strongly recommended. This procedure may be beneficial to precisely determine
the ductal extension of the disease, hence to decide whether or not hepatic resection
is needed as well as to confirm the histology.
