Extrahepatic cholangiocarcinoma: Current status of endoscopic approach and additional therapies

Table 1 Success rate and complications for percutaneous transhepatic biliary drainage, endoscopic ultrasound-guided biliary drainage, endoscopic retrograde cholangiopancreatography and self-expandable metal stent

Ref.	Procedure	Patients, n	Technical success %	Morbidity %
Artifon et al[50], 2012	PTBD, EUS-BD	12, 13	100, 100	25.00, 15.30
Bapaye et al[51], 2013	PTBD, EUS-BD	26, 25	46.00, 92.00	46.00, 20.00
Khashab et al[52], 2015	PTBD, EUS-BD	51, 22	100, 86.40	39.20, 18.20
Dhir et al[53], 2015	ERCP SEMS, EUS-BD	104, 104	94.23, 93.26	8.65, 8.65

ERCP: Endoscopic retrograde cholangiopancreatography; EUS-BD: Endoscopic ultrasound-guided biliary drainage; PTBD: Percutaneous transhepatic biliary drainage; SEMS: Self-expandable metal stent.

Table 2 Meta-analyses comparing self-expandable metal stents with plastic stents for the endoscopic drainage of distal malignant biliary obstruction

Ref.	Studies included	Patients, n	Procedures	Results
Almadi et al[62], 2017	20	1713	Endoscopic or percutaneous palliative biliary drainage with plastic stent vs SEMS	Stent patency 4.45 mo (95%CI: 0.31-8.59) in favor of SEMS; Overall survival 0.67 (95%CI: 0.66-1.99), no difference
Moole et al[33], 2017	11	947	Endoscopic palliative biliary drainage with plastic stent vs SEMS	Stent occlusion OR 0.48 (95%CI: 0.34-0.67) in favor of SEMS; Overall survival/time to death: (1) SEMS, 157.3 d (95%CI: 148.9-165.6), (2) Plastic, 120.6 d (95%CI: 114.3-126.9), P = 0.0024
Zorrón Pu et al[64], 2015	13	1133	Endoscopic palliative biliary drainage with plastic stent vs SEMS	Stent dysfunction, RD -0.26 (95%CI: -0.32 to -0.20) in favor of SEMS; Survival longer in the SEMS group (187 d vs 162 d, P < 0.0001)
Sawas et al[65], 2015	19	1989	Endoscopic or percutaneous palliative biliary drainage with plastic stent vs SEMS	Stent occlusion, HR 0.42 (95%CI: 0.27-0.64) in favor of SEMS; 30-d survival, HR 0.82 (95%CI: 0.45-1.48), no difference
Hong et al[66], 2013	10	785	Endoscopic palliative biliary drainage with plastic stent vs SEMS	Stent patency, HR 0.37 (95%CI: 0.28-0.48) in favor of SEMS; Survival, HR 0.81 (95%CI: 0.68-0.96) in favor of SEMS

CI: Confidence interval; HR: Hazard ratio; OR: Odds ratio; RCT: Randomized controlled trial; RD: Risk difference; SEMS: Self-expandable metal stent; WMD: Weighted mean difference.

Table 3 Photodynamic therapy in patients with cholangiocarcinoma

Ref.	No. patients	Median survival, d/mo	Adjuvant therapy
Ortner et al[106]	PDT 20, Control 19	493 d, 98 d	PDT -, Control -
Zoepf et al[103]	PDT 16, Control 16	630 d, 210 d	PDT -, Control -
Dumoulin et al[100]	PDT 24, Control 23	9.9 mo, 5.6 mo	PDT -, Control -
Kahaleh et al[102]	PDT 19, Control 21	8.0 mo, 5.0 mo	PDT, CTX 11; RTX 9; CTX 11, RTX 10
Witzigman et al[99]	PDT 68, Control 56	12.0 mo, 6.4 mo	PDT, CTX 6; RTX 2; CTX 5, RTX 1

CTX: Chemotherapy; PDT: Photodynamic therapy; RTX: Radiation therapy.