AUC, area under the curve; CA 19-9, carbohydrate antigen 19-9; CC

AUC, area under the curve; CA 19-9, carbohydrate antigen 19-9; CC, cholangiocarcinoma; CEA, carcinoembryonic antigen; CE-MS, capillary electrophoresis mass spectrometry; ERCP, endoscopic retrograde cholangiopancreaticography; LC-MS, liquid chromatography-mass spectrometry; PSC, primary sclerosing cholangitis; PTC, percutaneous transhepatic cholangiographies; ROC, receiver operating characteristic; SDS-PAGE, sodium

dodecylsulfate polyacrylamide gel electrophoresis; SVM, support vector machine. Bile samples were collected at the gastrointestinal endoscopy unit of the Hannover Medical School, Germany. We performed 142 endoscopic procedures and bile aspiration was successful in 75% of cases. From 94 consecutive patients included in the study, bile samples were successfully collected during 107 interventions (102 ERCs, five percutaneous transhepatic cholangiographies [PTC]). Indications for cholangiographic interventions were: PSC, CC, and choledocholithiasis. Ten patients developed CC in addition to PSC. Clinical cholangitis was present preintervention in one patient with choledocholithiasis,

in three patients with PSC, and in two patients with CC. We defined cholangitis as the presence of fever, elevated C-reactive protein (CRP), and alkaline phosphatase (AP). Antibiotic treatment before intervention was initiated in 30 out of 107 endoscopic procedures (seven choledocholithiasis, eight PSC, 15 CC).

We performed microbiological bile analysis in 93/107 examinations and bile remained sterile in only 15% of cases (1/30 choledocholithiasis, 7/36 PSC, 8/41 CC). Coexistent Avelestat (AZD9668) bacterial infection (bacteriobilia with fever, elevated CRP, AP, and gamma-GT) was present in six patients. Detailed patients characteristics and laboratory data are given in Table 1. The diagnosis of PSC was based on typical cholangiographic findings such as strictures or irregularity of intrahepatic or extrahepatic bile ducts after exclusion of secondary causes for sclerosing cholangitis. CC was proven histologically in 35 out of 38 patients. In three patients a definite histology could not be obtained, but clinical, laboratory, radiological, and ERCP findings were consistent with a diagnosis of CC. None of the patients with CC received chemotherapy before the cholangiographic intervention. The diagnosis of choledocholithiasis was based on ultrasound and/or endoscopic ultrasound and confirmed by ERC. The trial was approved by the local ethical committee of Hannover Medical School and written informed consent was obtained from all patients. Bile collection was performed as previously described.21 In brief, bile was aspirated by placing a 5F standard ERC catheter (without previous flushing) into the bile duct before contrast dye injection. Approximately 0.5 to 6 mL of bile (mean 2 mL) were collected and transferred into a sterile tube.

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