Review of endoscopic techniques in the diagnosis and management of cholangiocarcinoma

Abstract

Cholangiocarcinoma is a rare malignancy of the biliary tract. Key factors in determining therapeutic options include knowledge of tumor extent, anatomy and obtaining tissue diagnosis. Endoscopically, there are three modalities available to make the diagnosis of cholangiocarcinoma. These include endoscopic retrograde cholangiopancreatography, endoscopic ultrasound with fine needle aspiration and cholangioscopy. Management of cholangiocarcinoma endoscopically is typically confined to stent placement for palliative purposes or as a bridge to surgery. In this article, we will review the endoscopic techniques available for the diagnosis and management of cholangiocarcinoma.

Figure 1

Classification of cholangiocarcinoma. A: The classification of cholangiocarcinoma can be based on anatomic location, intrahepatic, hilar or extrahepatic; B: Nonhilar lesions can be described as mass-like, periductal or intraductal; C: Bismuth classification for hilar lesions.

Figure 2

Hilar lesion causing bilateral strictures at the bifurcation of the left and right hepatic ducts with proximal dilation.

Figure 3

A: Distal common bile duct lesion with proximal biliary dilation; B: Fine needle aspiration of common bile duct lesion; C: ERCP shows distal common bile duct stricture consistent with findings on EUS.

Figure 4

A: In this patient with a hilar mass, double stents were placed within the right and left hepatic systems to allow adequate drainage of contrast after cholangiogram was performed to decrease the risk of cholangitis; B: Endoscopic view of bilateral stents placed.