Published online Jun 25, 2015. doi: 10.4253/wjge.v7.i7.675
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
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.
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.