Late bile duct cancer complicating biliary-enteric anastomosis for benign disease

Background: Anastomosis between the biliary tree and the intestinal tract has been, and is, a relatively common procedure. Aside from cholangitis secondary to anastomotic stricture, it is generally regarded as innocuous. Methods: The recent experience with 3 patients who developed bile duct cancer many years after biliary-enteric anastomosis for benign disease prompted a review of whether the procedure was potentially carcinogenic. Results: There have been very few reports of late cholangiocarcinoma complicating this surgery for benign disease. However, there is some experimental evidence to support the hypothesis, and the time interval between surgery and the development of malignancy may be important. Conclusions: Reflux of duodenal or small intestinal contents into the biliary tree causes changes in the biliary epithelium that may be adaptive to the new environment but also have the potential to progress to malignant transformation.