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Background: The prognosis of bilio-pancreatic cancer (pancreas, bile duct and gallbladder) is poor due to the fact of late diagnosis. The only curative treatment for such tumors is surgery. The 5-year survival rate is still below 5% and less than one-third of patients suffering from such carcinomas are resectable at the time of diagnosis. Although specific tumor markers do exist, to date there is no screening marker for these diseases., Materials and Methods: Gallbladder bile of 44 consecutive cholecystectomized patients were prospectively analyzed for TAP concentrations. Group one (n = 14) consisted of the patients suffering from malignancies of the bilio-pancreatic system, group 2 (n = 22) comprised patients suffering from benign biliar or pancreatic diseases and group 3 (n = 6) included patients suffering from gastrointestinal carcinoma outside the bilio-pancreatic system with no affection of the bilio-pancreatic system., Results: The median TAP gallbladder bile concentration in malignant disease of the bilio-pancreatic system was 1328.00 nmol/l (range: 83.69-5133.00). Benign bilio-pancreatic disease revealed a median TAP bile concentration of 2.02 nmol/l equaling the concentration of patients suffering from other gastrointestinal carcinomas with a median of 2.00 nmol/l. In the control groups (2 + 3) there was a significant difference for TAP bile concentrations with an increase in the case of acute inflammation., Conclusion: Gallbladder bile TAP concentration discriminates between benign and malignant lesions of the bilio-pancreatic system. In the case of benign disease there is a significantly higher TAP concentration in the case of acute inflammation.

Background: The pre-operative differentiation of tumors of the pancreas, Papilla of Vater and the biliary tract is still unsatisfactory. Tumor marker analysis of the pancreatic juice did not improve the pre-operative diagnosis by a great deal., Methods: Bile from resected gallbladders of patients suffering from carcinomas of the pancreato-biliary system was analysed for CA 19-9, CEA, CA 72-4, CA 125 and AFP concentrations. The results were compared to patients suffering from acute cholecystitis, cholecystolithiasis as well as those suffering from benign tumors of the pancreato-biliary region., Results: Extreme high CA 19-9 concentrations were found in bile. Evaluations of the tumor-antigens CA 19-9, CA 72-4 and CEA in gallbladder bile were superior to any serum and pancreatic juice examination with respect to sensitivity and specificity. Observed sensitivities amounted to 100% for patients suffering from bile duct carcinoma (CA 19-9) and papillary carcinoma (CEA) at a specificity of 100%. CA 19-9 showed a sensitivity of 76.5% for pancreatic carcinomas at a specificity of 96.4%. CA 19-9 showed significant differences for the local tumor burden and for the degree of lymph node metastasis. Examination of tumor antigens in the gallbladder results in a high degree of discrimination for malignant and benign lesions of the subhepatic pancreato-biliary system., Conclusions: CA 19-9 must follow a entero-hepatic circulation, since it showed raised bile concentrations (factor: 10(4)) compared to serum analysis. Analysis of CA 19-9, CEA and CA 72-4 gives an opportunity for improvement in the detection of cancers of the pancreato-biliary system. Since the clinical important differentiation of tumors of the head of the pancreas (carcinoma vs. pancreatitis) remains unclear, an improvement by bile analyses must be assumed.