Advances in endoscopic retrograde cholangiopancreatography for the treatment of cholangiocarcinoma  

作　　者：Dushant S Uppal Andrew Y Wang 

机构地区：[1]Division of Gastroenterology and Hepatology, University of Virginia Health System

出　　处：《World Journal of Gastrointestinal Endoscopy》2015年第7期675-687,共13页世界胃肠内镜杂志（英文版）（电子版）

摘　　要：Cholangiocarcinoma(CCA) is a malignancy of the bileducts 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 ERCPdirected RFA as well, offer a survival advantage to patients with this difficult-to-treat malignancy.Cholangiocarcinoma （CCA） is a malignancy of the bileducts that carries high morbidity and mortality. Patientswith CCA typically present with obstructive jaundice,and associated complications of CCA include cholangitisand biliary sepsis. Endoscopic retrograde cholangiopancreatography（ERCP） is a valuable treatment modalityfor patients with CCA, as it enables internal drainageof blocked bile ducts and hepatic segments by usingplastic or metal stents. While there remains debate asto if bilateral （or multi-segmental） hepatic drainageis required and/or superior to unilateral drainage, theunderlying tenant of draining any persistently opacifiedbile ducts is paramount to good ERCP practice and goodclinical outcomes. Endoscopic therapy for malignantbiliary strictures from CCA has advanced to includeablative therapies via ERCP-directed photodynamictherapy （PDT） or radiofrequency ablation （RFA）. WhileERCP techniques cannot cure CCA, advancements inthe field of ERCP have enabled us to improve upon thequality of life of patients with inoperable and incurabledisease. ERCP-directed PDT has been used in lieu ofbrachytherapy to provide neoadjuvant local tumorcontrol in patients with CCA who are awaiting livertransplantation. Lastly, mounting evidence suggeststhat palliative ERCP-directed PDT, and probably ERCPdirectedRFA as well, offer a survival advantage topatients with this difficult-to-treat malignancy.

关 键 词：Endoscopic retrograde cholangiopancreatography CHOLANGIOCARCINOMA STENTS Self-expandablemetal stents Photodynamic therapy PHOTODYNAMICTHERAPY Radiofrequency ablation RADIOFREQUENCYABLATION 

分 类 号：R735.8[医药卫生—肿瘤]