Biliary Inflammation and Biliary Carcinogenesis

Abstract

Biliary carcinoma has been reported as a late complication of bilioenterostomy. The present study was designed to find out if bilioenterostomy promotes biliary carcinogenesis, and to clarify the relationship between biliary inflammation and biliary carcinogenesis in hamsters. Syrian hamsters were subjected to simple laparotomy (SL), choledochoduodenostomy (CD), or choledochojejunostomy (CJ). All hamsters received subcutaneous injections of the chemical carcinogen, N-nitrosobis(2-oxopropyl)amine (BOP), and were killed 20 weeks after surgery. Neoplastic lesions in the biliary tree were examined histologically, and the presence and degree of cholangitis was evaluated with special reference to the biliary carcinogenesis. The incidence of bile duct carcinoma did not differ significantly among the three groups. However, numerous bile duct carcinomas were recognized in the bilioenterostomized animals, especially in the CJ group. Moreover, there was a significant correlation between biliary carcinogenesis and the presence of cholangitis in the CD and CJ groups, but not in the SL control group. Severe cholangitis was evident in the CJ group, and the number of biliary carcinomas was well correlated with the degree of cholangitis. These findings suggest that the risk of carcinoma in the biliary tract is increased when cholangitis persists after biliary reconstruction.