Modern gastrointestinal endoscopic techniques for biliary tract cancers

Area of Science:

• Gastroenterology and Oncology
• Interventional Endoscopy

Background:

• Biliary tract cancers (cholangiocarcinomas, CCAs) originate from biliary tree epithelial cells.
• CCAs are classified by location: intra-hepatic, peri-hilar, or distal extra-hepatic.
• Endoscopy traditionally aids CCA diagnosis and biliary decompression.

Purpose of the Study:

• To review the evolving role of endoscopy in diagnosing and managing biliary tract cancers.
• To discuss advancements in endoscopic diagnostic and therapeutic interventions for CCAs.
• To explore emerging endoscopic techniques for CCA treatment.

Main Methods:

• Review of diagnostic endoscopic modalities including ERCP, cholangioscopy, and EUS-FNA.
• Analysis of endoscopic biliary decompression strategies and stenting options (metal vs. plastic).
• Discussion of novel therapeutic endoscopic interventions such as RFA and drug-eluting stents.

Main Results:

• ERCP brushings/biopsies and EUS-FNA have limitations in sensitivity and carry risks like tumor seeding.
• Cholangioscopy enhances diagnostic accuracy through targeted biopsies and visual assessment.
• Optimal biliary decompression requires draining at least 50% of liver function, with ongoing debate on endoscopic vs. percutaneous superiority for hilar tumors.
• Metal stents show benefits but are generally permanent; plastic stents are an alternative.
• Emerging techniques like radiofrequency ablation and drug-eluting stents offer new treatment avenues.

Conclusions:

• Endoscopic techniques are advancing for improved diagnosis and management of biliary tract cancers.
• Cholangioscopy and EUS offer more precise diagnostic capabilities.
• Future endoscopic interventions hold promise for direct treatment of CCAs.