Review
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Endosc. Jun 10, 2015; 7(6): 582-592
Published online Jun 10, 2015. doi: 10.4253/wjge.v7.i6.582
Cholangiocarcinoma and malignant bile duct obstruction: A review of last decades advances in therapeutic endoscopy
Helga Bertani, Marzio Frazzoni, Santi Mangiafico, Angelo Caruso, Mauro Manno, Vincenzo Giorgio Mirante, Flavia Pigò, Carmelo Barbera, Raffaele Manta, Rita Conigliaro
Helga Bertani, Santi Mangiafico, Angelo Caruso, Mauro Manno, Vincenzo Giorgio Mirante, Flavia Pigò, Carmelo Barbera, Raffaele Manta, Rita Conigliaro, Digestive Endoscopy Unit, Baggiovara Hospital, 41126 Modena, Italy
Marzio Frazzoni, Digestive Pathophysiology Unit, Baggiovara Hospital, 41126 Modena, Italy
Author contributions: Bertani H contributed to concept and design of the review, drafting of the manuscript; Pigò F contributed to drafting of the manuscript; Frazzoni M, Mangiafico S, Caruso A, Manno M, Mirante VG and Conigliaro R contributed to concept of the review, critical revision of the manuscript; all authors contributed to this manuscript.
Conflict-of-interest: The authors have no conflict of interests to declare.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (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/
Correspondence to: Helga Bertani, MD, Digestive Endoscopy Unit, Baggiovara Hospital, Viale Giardini 1355, 41126 Modena, Italy. helga88@libero.it
Telephone: +39-59-3961269 Fax: +39-59-3961216
Received: October 28, 2014
Peer-review started: November 5, 2014
First decision: December 26, 2014
Revised: February 16, 2015
Accepted: March 16, 2015
Article in press: March 18, 2015
Published online: June 10, 2015
Abstract

In the last decades many advances have been achieved in endoscopy, in the diagnosis and therapy of cholangiocarcinoma, however blood test, magnetic resonance imaging, computed tomography scan may fail to detect neoplastic disease at early stage, thus the diagnosis of cholangiocarcinoma is achieved usually at unresectable stage. In the last decades the role of endoscopy has moved from a diagnostic role to an invaluable therapeutic tool for patients affected by malignant bile duct obstruction. One of the major issues for cholangiocarcinoma is bile ducts occlusion, leading to jaundice, cholangitis and hepatic failure. Currently, endoscopy has a key role in the work up of cholangiocarcinoma, both in patients amenable to surgical intervention as well as in those unfit for surgery or not amenable to immediate surgical curative resection owing to locally advanced or advanced disease, with palliative intention. Endoscopy allows successful biliary drainage and stenting in more than 90% of patients with malignant bile duct obstruction, and allows rapid reduction of jaundice decreasing the risk of biliary sepsis. When biliary drainage and stenting cannot be achieved with endoscopy alone, endoscopic ultrasound-guided biliary drainage represents an effective alternative method affording successful biliary drainage in more than 80% of cases. The purpose of this review is to focus on the currently available endoscopic management options in patients with cholangiocarcinoma.

Keywords: Cholangiocarcinoma, Malignant bile duct obstruction, Interventional endoscopy, Endoscopic therapy, Self-expandable metal stent

Core tip: Cholangiocarcinoma are an heterogeneous group of tumor and represent a challenge in medicine because of the difficulty in establishing the diagnosis and an high recurrence rate after surgery which represents the only curative treatment. Endoscopy has gained a pivotal role in the management of the disease, before surgery if patient is amenable to surgical intervention or in those unfit for surgery. New stent prototype able to release drugs and/or photodynamic therapy have been commercialized with promising results. When endoscopy fails, endoscopic ultrasound-guided biliary drainage represents an effective alternative method affording biliary drainage.