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Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Endosc. Jun 25, 2015; 7(7): 675-687
Published online Jun 25, 2015. doi: 10.4253/wjge.v7.i7.675
Advances in endoscopic retrograde cholangiopancreatography for the treatment of cholangiocarcinoma
Dushant S Uppal, Andrew Y Wang
Dushant S Uppal, Andrew Y Wang, Division of Gastroenterology and Hepatology, University of Virginia Health System, Charlottesville, VA 22908, United States
Author contributions: Uppal DS and Wang AY contributed equally to this manuscript.
Conflict-of-interest: The authors have no conflicts of interest, financial or otherwise, to report with respect to this manuscript.Dr. Wang discloses that he has received research support from Cook Medical on the topic of metal biliary stents.
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: Andrew Y Wang, MD, FACG, FASGE, Associate Professor of Medicine, Co-Medical Director of Endoscopy, Division of Gastroenterology and Hepatology, University of Virginia Health System, Box 800708, Charlottesville, VA 22908, United States. ayw7d@virginia.edu
Telephone: +1-434-9241653 Fax: +1-434-2447590
Received: September 11, 2014
Peer-review started: September 11, 2014
First decision: December 17, 2014
Revised: January 22, 2015
Accepted: February 9, 2015
Article in press: February 11, 2015
Published online: June 25, 2015
Processing time: 300 Days and 1.5 Hours
Abstract

Cholangiocarcinoma (CCA) is a malignancy of the bile ducts that carries high morbidity and mortality. Patients with CCA typically present with obstructive jaundice, and associated complications of CCA include cholangitis and biliary sepsis. Endoscopic retrograde cholangiopancreatography (ERCP) is a valuable treatment modality for patients with CCA, as it enables internal drainage of blocked bile ducts and hepatic segments by using plastic or metal stents. While there remains debate as to if bilateral (or multi-segmental) hepatic drainage is required and/or superior to unilateral drainage, the underlying tenant of draining any persistently opacified bile ducts is paramount to good ERCP practice and good clinical outcomes. Endoscopic therapy for malignant biliary strictures from CCA has advanced to include ablative therapies via ERCP-directed photodynamic therapy (PDT) or radiofrequency ablation (RFA). While ERCP techniques cannot cure CCA, advancements in the field of ERCP have enabled us to improve upon the quality of life of patients with inoperable and incurable disease. ERCP-directed PDT has been used in lieu of brachytherapy to provide neoadjuvant local tumor control in patients with CCA who are awaiting liver transplantation. Lastly, mounting evidence suggests that palliative ERCP-directed PDT, and probably ERCP-directed RFA as well, offer a survival advantage to patients with this difficult-to-treat malignancy.

Keywords: Endoscopic retrograde cholangiopancreatography, Cholangiocarcinoma, Stents, Self-expandable metal stents, Photodynamic therapy, Photodynamic therapy, Radiofrequency ablation, Radiofrequency ablation

Core tip: Endoscopic retrograde cholangiopancreatography (ERCP) is a valuable treatment modality for patients with cholangiocarcinoma (CCA), as it enables luminal drainage of blocked bile ducts and hepatic segments by using plastic or metal stents. While there remains some debate as to if bilateral hepatic drainage is required and/or superior to unilateral drainage, the underlying tenant of draining any persistently opacified bile ducts is paramount to good ERCP practice. Although ERCP interventions cannot cure CCA, advancements in the field of ERCP, including ERCP-directed photodynamic therapy and radiofrequency ablation, likely confer a survival advantage and improve upon the quality of life of patients with incurable disease.