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Digestive Disease Interventions 2024; 08(04): 256-262
DOI: 10.1055/s-0044-1787960
Review Article

Endoscopic Ablation of Perihilar Biliary Malignancies

Ross C. D. Buerlein 
1   Division of Gastroenterology and Hepatology, University of Virginia Health System, Charlottesville, Virginia
,
Arjun Kundra
1   Division of Gastroenterology and Hepatology, University of Virginia Health System, Charlottesville, Virginia
,
Andrew Y. Wang
1   Division of Gastroenterology and Hepatology, University of Virginia Health System, Charlottesville, Virginia
› Author Affiliations Financial Disclosures R.C.D.B.: no financial disclosures.
A.K.: no financial disclosures.
A.Y.W.: discloses publicly owned stock equity in Pfizer and GE HealthCare Technologies.
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Abstract

Cholangiocarcinoma (CCA) is a malignancy arising from biliary epithelial cells and is subdivided based on the location within the biliary tree. The treatment of CCA differs based on the anatomical involvement within the biliary tree. Perihilar CCA (pCCA) arises between the cystic duct and the secondary branches of the right and left hepatic ducts. Surgical resection and liver transplantation offer the only hope for cure in pCCA, but, unfortunately, more than 80% of patients are considered surgically unresectable at the time of diagnosis resulting in a limited overall life expectancy of less than 1 year. For patients with surgically unresectable pCCA, treatment options are limited and include chemotherapy/chemoradiotherapy and biliary drainage via endoscopic stenting or percutaneous drainage with minimal overall survival benefits. However, endobiliary ablation options like photodynamic therapy (PDT), radiofrequency ablation (RFA), and, to a lesser degree, intraluminal brachytherapy have shown improvements in overall survival and improvements in stent patency and now should be considered for all cases of surgically unresectable pCCA. In fact, the 2023 American College of Gastroenterology (ACG) Clinical Guidelines on the diagnosis and management of biliary strictures recommend endobiliary ablation (PDT or RFA) for patients with surgically unresectable pCCA rather than stenting alone.

Keywords

cholangiocarcinoma - endobiliary ablation - radiofrequency ablation - photodynamic therapy - brachytherapy


Publication History

Received: 07 May 2024

Accepted: 30 May 2024

Article published online:
27 June 2024

© 2024. Thieme. All rights reserved.

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