The role of endoscopy in biliary cancer

Fred M. Konikoff*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

Abstract

Biliary tract cancer is the second most common primary hepatobiliary malignancy, after hepatocellular carcinoma. Gallbladder cancer is the most common type, while bile duct and ampullary cancers comprise together about a third of cases. Cholangiocarcinoma, the primary bile duct cancer has a poor prognosis, and only a minority of the tumors, mainly those in the distal duct, are amenable to possibly curative surgery. Endoscopy plays a central role in the diagnosis as well as in the palliative therapy of most patients. In the diagnostic process tissue sampling by brush cytology, directed biopsy, fine needle aspiration or bile sampling for cytology or tumor markers are all being used, with widely variable success rates. Although the specificity of most methods is nearly 100%, the sensitivity is significantly less. By combining two or three methods one can increase the sensitivity from around 30 to over 70%. Endoscopic palliation by endoprosthesis placement is preferable in distal lesions. It is associated with less procedure related mortality, less major complications and a shorter hospitalization than surgery. The more frequent recurrence of jaundice is treated by stent exchange. Plastic stents are cheaper, but have a shorter mean patency, and a higher migration rate than metallic stents. Hilar (Klatskin) tumors often require metallic or multiple stents to provide adequate drainage, and the success rate is particularly operator dependent. In all forms of drainage - endoscopic, percutaneus or surgical - the overall outcome, however, depends more on the stage of disease and patient status than the drainage strategy.

Original languageEnglish
Pages (from-to)165-168
Number of pages4
JournalGastrointestinal Oncology
Volume4
Issue number2-3
DOIs
StatePublished - Jul 2002

Keywords

  • Cholangiocarcinoma
  • ERCP
  • Endoscopy
  • Klatskin tumor
  • Stenting

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