Endoscopic retrograde cholangiopancreatography for cholangiocarcinoma

Cholangiocarcinoma is an increasingly common malignancy. Patients usually present with biliary obstruction. The role of endoscopic retrograde cholangiopancreatography (ERCP) is almost exclusively for drainage of the biliary tree, although diagnostic ERCP is still performed at the time of drainage to obtain a tissue diagnosis using brush cytology and intraductal biopsies. Peroral cholangioscopy may facilitate tissue diagnosis by allowing for directed biopsies. Biliary drainage is achieved by endoscopic stent placement. Careful preprocedural planning is necessary to select the ideal areas for drainage and to minimize contrast injection and subsequent cholangitis in hilar lesions.