Flowcharts for the management of biliary tract and ampullary carcinomas

Shuichi Miyakawa, Shin Ishihara, Tadahiro Takada, Masaru Miyazaki, Kazuhiro Tsukada, Masato Nagino, Satoshi Kondo, Junji Furuse, Hiroya Saito, Toshio Tsuyuguchi, Fumio Kimura, Hideyuki Yoshitomi, Satoshi Nozawa, Masahiro Yoshida, Keita Wada, Hodaka Amano, Fumihiko Miura

Research output: Contribution to journalArticlepeer-review

27 Citations (Scopus)


No strategies for the diagnosis and treatment of biliary tract carcinoma have been clearly described. We developed flowcharts for the diagnosis and treatment of biliary tract carcinoma on the basis of the best clinical evidence. Risk factors for bile duct carcinoma are a dilated type of pancreaticobiliary maljunction (PBM) and primary sclerosing cholangitis. A nondilated type of PBM is a risk factor for gallbladder carcinoma. Symptoms that may indicate biliary tract carcinoma are jaundice and pain in the upper right area of the abdomen. The first step of diagnosis is to carry out blood biochemistry tests and ultrasonography (US) of the abdomen. The second step of diagnosis is to find the local extension of the carcinoma by means of computed tomography (CT), magnetic resonance imaging (MRI), magnetic resonance cholangiopancreatography (MRCP), percutaneous transhepatic cholangiography (PTC), and endoscopic retrograde cholangiopancreatography (ERCP). Because resection is the only way to completely cure biliary tract carcinoma, the indications for resection are determined first. In patients with resectable disease, the indications for biliary drainage or portal vein embolization (PVE) are checked. In those with nonresectable disease, biliary stenting, chemotherapy, radiotherapy, and/or best supportive care is selected.

Original languageEnglish
Pages (from-to)7-14
Number of pages8
JournalJournal of Hepato-Biliary-Pancreatic Surgery
Issue number1
Publication statusPublished - 01-2008

All Science Journal Classification (ASJC) codes

  • Surgery
  • Hepatology


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