Volatile organic compounds in bile can diagnose malignant biliary strictures in the setting of pancreatic cancer: a preliminary observation

Gastrointest Endosc. 2014 Dec;80(6):1038-45. doi: 10.1016/j.gie.2014.04.016. Epub 2014 Jun 11.


Background: Ascertaining the nature of biliary strictures is challenging. The role of volatile organic compounds (VOCs) in bile in determining the cause of biliary strictures is not known.

Objective: To identify potential VOCs in the headspaces (gas above the sample) of bile in patients with malignant biliary strictures from pancreatic cancer.

Design: Prospective cross-sectional study.

Setting: Referral center.

Patients: Prospective study in which bile was aspirated in 96 patients undergoing ERCP for benign and malignant conditions.

Main outcome measurements: Selected ion flow tube mass spectrometry (VOICE200R SIFT-MS instrument; Syft Technologies Ltd, Christchurch, New Zealand) was used to analyze the headspace and to build a predictive model for pancreatic cancer.

Results: The headspaces from 96 bile samples were analyzed, including 24 from patients with pancreatic cancer and 72 from patients with benign biliary conditions. The concentrations of 6 compounds (acetaldehyde, acetone, benzene, carbon disulfide, pentane, and trimethylamine [TMA]) were increased in patients with pancreatic cancer compared with controls (P < .05). By using receiver-operating characteristic curve analysis, we developed a model for the diagnosis of pancreatic cancer based on the levels of TMA, acetone, isoprene, dimethyl sulfide, and acetaldehyde. The model [10.94 + 1.8229* log (acetaldehyde) + 0.7600* log (acetone) - 1.1746* log (dimethyl sulfide) + 1.0901* log (isoprene) - 2.1401 * log (trimethylamine) ≥ 10] identified the patients with pancreatic cancer (area under the curve = 0.85), with 83.3% sensitivity and 81.9% specificity.

Limitations: Sample size.

Conclusions: The measurement of biliary fluid VOCs may help to distinguish malignant from benign biliary strictures. Further studies are warranted to validate these observations. (Clinical Trial Registration Number NCT01565460.).

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Acetaldehyde / analysis
  • Acetone / analysis
  • Benzene / analysis
  • Bile / chemistry*
  • Biliary Tract Diseases / diagnosis
  • Carbon Disulfide / analysis
  • Case-Control Studies
  • Choledocholithiasis / diagnosis*
  • Constriction, Pathologic / diagnosis
  • Cross-Sectional Studies
  • Female
  • Humans
  • Logistic Models
  • Male
  • Mass Spectrometry
  • Methylamines / analysis
  • Pancreatic Neoplasms / diagnosis*
  • Pancreatitis, Chronic / diagnosis*
  • Pentanes / analysis
  • Prospective Studies
  • ROC Curve
  • Sensitivity and Specificity
  • Sphincter of Oddi Dysfunction / diagnosis*
  • Volatile Organic Compounds / analysis*


  • Methylamines
  • Pentanes
  • Volatile Organic Compounds
  • Acetone
  • pentane
  • Acetaldehyde
  • Benzene
  • trimethylamine
  • Carbon Disulfide

Associated data

  • ClinicalTrials.gov/NCT01565460