2015 ASGE指南：内镜在胰腺实体肿瘤患者评估和管理中的作用

This document reviews the approach to the evaluation and treatment of the patient with suspected biliary neoplasia (Table 2). A discussion of the role of endoscopy for ampullary adenomas can be found in another ASGE document. Patients with biliary neoplasia may present with abnormal imaging studies or serum chemistries or with symptoms such as jaundice, abdominal pain, anorexia, and weight loss.  Elevations of bilirubin and alkaline phosphatase suggest biliary obstruction. A history of inflammatory

bowel disease should be sought and a complete physical examination should be performed. Once there is clinical suspicion of biliary neoplasia, further investigation with abdominal imaging studies is appropriate. A chest x-ray or CT scan may also be appropriate to assist in diagnosis, staging, and therapeutic planning. Obtaining serum markers, such as CA 19-9 and carcinoembryonic antigen, may be considered, but their utility is controversial.3,4