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Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Hepatol. Feb 27, 2021; 13(2): 166-186
Published online Feb 27, 2021. doi: 10.4254/wjh.v13.i2.166
Extrahepatic cholangiocarcinoma: Current status of endoscopic approach and additional therapies
Alina Ioana Tantau, Alina Mandrutiu, Anamaria Pop, Roxana Delia Zaharie, Dana Crisan, Carmen Monica Preda, Marcel Tantau, Voicu Mercea
Alina Ioana Tantau, Department of Internal Medicine and Gastroenterology, “Iuliu Hatieganu” University of Medicine and Pharmacy, 4th Medical Clinic, Cluj-Napoca 400012, Cluj, Romania
Alina Mandrutiu, Anamaria Pop, Department of Gastroenterology and Hepatology, Gastroenterology and Hepatology Medical Center, Cluj-Napoca 400132, Cluj, Romania
Roxana Delia Zaharie, Department of Gastroenterology, “Prof. Dr. Octavian Fodor” Regional Institute of Gastroenterology and Hepatology, Cluj-Napoca 400162, Cluj, Romania
Roxana Delia Zaharie, Department of Gastroenterology, “Iuliu Hatieganu” University of Medicine and Pharmacy, Cluj-Napoca 400012, Cluj, Romania
Dana Crisan, Internal Medicine Department, Cluj-Napoca Internal Medicine Department, “Iuliu Hatieganu” University of Medicine and Pharmacy, 5th Medical Clinic, Cluj-Napoca 400012, Cluj, Romania
Carmen Monica Preda, Department of Gastroenterology and Hepatology, Clinic Fundeni Institute, “Carol Davila” University of Medicine and Pharmacy, Bucharest 22328, Romania
Marcel Tantau, Voicu Mercea, Department of Internal Medicine and Gastroenterology, “Prof. Dr. Octavian Fodor” Regional Institute of Gastroenterology and Hepatology, Cluj-Napoca 400162, Cluj, Romania
Marcel Tantau, Voicu Mercea, Department of Internal Medicine and Gastroenterology, “Iuliu Hatieganu“ University of Medicine and Pharmacy, Cluj-Napoca 400012, Cluj, Romania
Author contributions: Tantau AI and Zaharie RD wrote the paper; Mandrutiu A, Crisan D, Pop A, Mercea V and Preda CM collected the data and drafted the paper; Tantau M revised the paper; Tantau AI and Tantau M provided the endoscopic images from their personal collection; All authors contributed their expert opinion to the concept of the paper and critically revised the article; All authors approved the final article version to be published.
Conflict-of-interest statement: The authors declare no conflicts of interest.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Roxana Delia Zaharie, MD, PhD, Assistant Lecturer, Department of Gastroenterology, “Prof. Dr. Octavian Fodor“ Regional Institute of Gastroenterology and Hepatology, 19-21 Croitorilor Street, Cluj-Napoca 400162, Cluj, Romania. endoscopict.correspondence@gmail.com
Received: June 27, 2020
Peer-review started: June 27, 2020
First decision: November 4, 2020
Revised: December 2, 2020
Accepted: December 13, 2020
Article in press: December 13, 2020
Published online: February 27, 2021
Processing time: 242 Days and 20.1 Hours
Abstract

The prognosis of patients with advanced or unresectable extrahepatic cholangiocarcinoma is poor. More than 50% of patients with jaundice are inoperable at the time of first diagnosis. Endoscopic treatment in patients with obstructive jaundice ensures bile duct drainage in preoperative or palliative settings. Relief of symptoms (pain, pruritus, jaundice) and improvement in quality of life are the aims of palliative therapy. Stent implantation by endoscopic retrograde cholangiopancreatography is generally preferred for long-term palliation. There is a vast variety of plastic and metal stents, covered or uncovered. The stent choice depends on the expected length of survival, quality of life, costs and physician expertise. This review will provide the framework for the endoscopic minimally invasive therapy in extrahepatic cholangiocarcinoma. Moreover, additional therapies, such as brachytherapy, photodynamic therapy, radiofrequency ablation, chemotherapy, molecular-targeted therapy and/or immunotherapy by the endoscopic approach, are the nonsurgical methods associated with survival improvement rate and/or local symptom palliation.

Keywords: Cholangiocarcinoma; Endoscopic drainage; Endoscopic retrograde cholangiopancreatography; Photodynamic therapy; Radiofrequency ablation; Brachytherapy

Core Tip: Cholangiocarcinoma is an aggressive tumor with a poor prognosis mainly due to its late diagnosis. The development of new minimally invasive techniques provides these patients a chance to relieve symptoms and attain a better quality of life. We herein discuss the palliation of obstructive jaundice by radiofrequency ablation, photodynamic therapy and brachytherapy in advanced extrahepatic cholangiocarcinoma.