Published online Feb 27, 2021. doi: 10.4254/wjh.v13.i2.166
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
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.
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.