The possible factors associated with positive malignant findings in tissue sampling by forceps biopsy included stricture level, level of serum CEA, CA 19-9 and alkaline phosphatase, serum bilirubin >10 mg/dL, numbers of biopsy specimens, biopsy specimens ≧5, and biopsy specimens ≧3 revealed no statistically significant results in all malignant, cholangiocarcinoma, and pancreatic head cancer groups. The gene discussed is CEACAM5; the disease is cholangiocarcinoma.