Metabolomics of Duodenal Juice for Biliary Tract Cancer Diagnosis

SIMPLE SUMMARY: Biliary tract carcinoma (BTC) has an extremely poor prognosis, with a 5-year survival rate of less than 30%. However, the sensitivity and accuracy of current diagnostic tools, such as blood tumor marker and pathological diagnosis via endoscopic retrograde cholangiography (ERC), is low. Our study aimed to perform a metabolomic analysis of duodenal juice, which can be collected noninvasively, as a novel diagnostic method, and to investigate its added value as a biomarker for the diagnosis of BTC. We collected duodenal juice from 67 patients and performed metabolomic analysis prospectively. We found differences in the metabolome between malignant and benign biliary diseases. The metabolomic analysis of duodenal juice is feasible and available for differential diagnosis of biliary diseases’ malignancy and benignancy. ABSTRACT: The poor prognosis of malignant biliary diseases is partially caused by their difficult early diagnosis. Therefore, many patients are only diagnosed at advanced stages. This study aimed to improve diagnosis by clarifying the differences in the duodenal juice metabolomes of benign and malignant biliary diseases. From October 2021 to January 2023, duodenal juice was obtained from 67 patients with suspected biliary diseases who required endoscopic ultrasonography and endoscopic retrograde cholangiography for diagnosis/treatment. The samples metabolomes were analyzed via nuclear magnet resonance spectroscopy using an 800-MHz spectrometer. Metabolomes of malignant and benign diseases were then compared, and multivariate analysis was performed to determine the relevant factors for malignancy/benignancy. For benignancy, no significant predictors were observed. For malignancy, acetone was a significant predictor, with higher concentrations in the malignant group than in the benign group. Regarding the receiver operating characteristic curve analysis for biliary tract carcinoma diagnosis, the predictive value of acetone in duodenal juice was comparable with serum CA19-9 levels (area under the curve: 0.7330 vs. 0.691, p = 0.697). In conclusion, duodenal juice metabolomics is a feasible method that is available for differential diagnosis in the biliary disease field.