Periampullary and Bile Duct Diseases

UCLA provides comprehensive care for periampullary and bile duct diseases in one convenient clinic. Our interventional endoscopy team can often deliver diagnosis, treatment and pain relief in a single outpatient visit.

Periampullary and Bile Duct Diseases We Treat

UCLA has the largest team of interventional endoscopy experts in Los Angeles. This team of specialists provides minimally invasive diagnosis and treatment, using a flexible tube (endoscope) inserted into the digestive tract. With interventional endoscopy, patients can often avoid surgery.

Periampullary and bile duct diseases we treat include:

• Bile duct cysts (choledochal cysts)
• Cholangiocarcinoma (bile duct cancer)
• Duodenal cancer and polyps
• Ampullary cancer

Choledochal Cysts (Bile Duct Cysts)

Choledochal cysts are a relatively rare condition that causes enlargement of the bile duct, which carries bile (digestive juices) from the liver and gallbladder. There are several types of bile duct cysts, some of which may increase a patient’s risk of cholangiocarcinoma (bile duct cancer) if left untreated.

What Causes Choledochal Cysts?

In many cases, bile duct cysts are a genetically inherited condition. They can also develop later in adulthood for unknown reasons.

Choledochal Cyst Symptoms

Symptoms vary in patients with bile duct cysts and may include:

• Abdominal pain
• Repeat episodes of acute pancreatitis
• Jaundice (yellowing of skin and eyes)

Diagnosing Choledochal Cysts

Bile duct cysts are typically diagnosed with imaging tests, such as ultrasound, CT (computerized tomography) scans or MRI (magnetic resonance imaging) scans. Your doctor may also use procedures like ERCP (endoscopic retrograde cholangiopancreatography) or PTC (percutaneous transhepatic cholangiopancreatography) to take X-rays of your bile duct.

Choledochal Cyst Treatment at UCLA

In some cases, doctors may recommend surgery to remove a bile duct cyst. This is usually the case if you experience repeated infection or the cyst presents a cancer risk.

UCLA is one of the highest volume pancreatic surgery centers in the area. Our team operates on more than 100 patients every year. This advanced experience often means faster recovery with fewer complications for our patients.

Cholangiocarcinoma (Bile Duct Cancer)

Cholangiocarcinoma, or bile duct cancer, is a malignant (cancerous) growth in one of the bile ducts. It is a rare disease that occurs in roughly 2 out of 100,000 people.

What Causes Cholangiocarcinoma?

There are several risk factors for cholangiocarcinoma. These include:

• Choledochal cysts (bile duct cysts)
• Chronic irritation due to backup of bile
• History of liver fluke disease, a parasitic infection
• A history of primary sclerosing cholangitis, a disease that creates scars in the bile ducts

Cholangiocarcinoma Symptoms

Symptoms of bile duct cancer are similar to other pancreatic diseases and may include:

• Abdominal pain
• Weight loss
• Jaundice
• Fever and chills
• Itching
• Clay-colored stools

Diagnosing Cholangiocarcinoma

Doctors may use several tests to identify tumors or bile duct blockages:

• Abdominal ultrasound
• CT scan
• Biopsy
• Minimally invasive endoscopic techniques such as ERCP or EUS (endoscopic ultrasound)
• PTC
• Blood tests to analyze liver function

Learn more about our advanced imaging and diagnosis capabilities.

Cholangiocarcinoma Treatment at UCLA

Treatment for bile duct cancer depends on whether the tumor is confined to the bile duct or whether it has spread to other parts of your body. If possible, doctors will surgically remove the tumor and likely prescribe chemotherapy and radiation to lower the chances of it returning.

If the cancer has spread and can’t be removed completely, however, chemotherapy and radiation are typically given alone. Interventional endoscopy treatments or surgery to remove blockages can also relieve symptoms.

Duodenal Cancer and Polyps

Duodenal cancer is a malignant (cancerous) growth in the first part of the small intestine (the duodenum). Since duodenal polyps can develop into duodenal cancer, they are usually removed surgically.

What Causes Duodenal Cancer and Polyps?

There are several risk factors for duodenal cancer:

• Having a high-fat diet
• Crohn’s disease
• Celiac disease
• A history of FAP (familial adenomatous polyposis), an inherited condition marked by polyps (growths) in the colon or rectum

Symptoms of Duodenal Cancer and Polyps

Symptoms of duodenal cancer include:

• Abdominal pain
• Unexplained weight loss
• Bloody stool

Symptoms of duodenal polyps are similar to those of duodenal cancer and may also include jaundice. See a doctor if you are experiencing any of these symptoms.

Diagnosing Duodenal Cancer and Polyps

Your doctor may recommend several tests to diagnose duodenal cancer or polyps:

• Blood tests, including liver function tests
• Imaging tests, such as CT scan or MRI
• Biopsy to remove and analyze cells for cancer
• Endoscopic imaging

Treatment for Duodenal Cancer and Polyps at UCLA

Doctors often recommend surgery for duodenal cancer, typically performing a Whipple procedure. UCLA surgeons perform between 100 and 150 of these complex surgeries each year, making ours one of the most experienced pancreatic cancer surgery centers in the region.

Patients may also receive chemotherapy and radiation therapy, depending on their tumor size and lymph node involvement.

Ampullary Cancer

Ampullary cancer occurs in the ampulla of Vater, where the bile duct and pancreatic duct meet. Symptoms, diagnosis and treatment all closely resemble what happens with pancreatic cancer.