Endoscopic Ablation in Cholangiocarcinoma

Cholangiocarcinoma is a rare, highly aggressive malignancy of the hepatobiliary tract with poor prognosis, often diagnosed at advanced stages when curative surgical resection is not feasible. Management increasingly relies on advanced endoscopic interventions to address malignant biliary obstruction and improve clinical outcomes. Beyond conventional biliary stenting, adjunctive endoscopic ablation therapies have emerged as promising strategies to improve both stent patency and survival. This review comprehensively examines the evolving role of radiofrequency ablation and photodynamic therapy in the treatment of unresectable cholangiocarcinoma. Radiofrequency ablation utilizes localized thermal energy to induce coagulative tumor necrosis and offers advantages including procedural simplicity, favorable safety profile, and cost-effectiveness; however, its efficacy may be limited by tumor size, location, and proximity to critical structures. In contrast, photodynamic therapy employs light-activated photosensitizers to selectively induce cytotoxicity in malignant tissue, demonstrating superior outcomes in prolonging both stent patency and overall survival across multiple studies and meta-analyses. Photodynamic therapy's ability to treat more diffuse and peripheral lesions represents an important advantage, though its use is limited by photosensitivity reactions and shallow tissue penetration. Ultimately, endoscopic ablation therapies represent valuable adjunctive options in the multidisciplinary care of patients with unresectable cholangiocarcinoma. As technological advances continue and more comparative data emerge, optimized patient selection and individualized integration of these therapies hold potential to significantly improve outcomes in this challenging malignancy.