Strategy for ERCP stenting in cholangiocarcinoma

Abstract

Considering the steadily growing incidence of cholangiocarcinoma (CCA) worldwide, there is a constant need to re-evaluate and re-think its pathophysiology, diagnostic modalities, and mostly important, its treatment. No matter the histopathological appearance, endoscopic procedures - mainly Endoscopic Retrograde Cholangiopancreatography (ERCP) with stenting - are often used in the treatment of CCA complications, such as biliary obstruction when biliary drainage is indicated. Indications for preoperative biliary drainage in surgical cases are adjusted to each patient’s status. On the contrary, palliative drainage is the first option for relieving symptoms and improving the quality of life in the context of locally advanced and unresectable CCA. Further, concern about stenting techniques depends on the stricture location: Bismuth-Corlette types I and II are usually endoscopically drained with one stent placed in biliary tract, while for types III and IV, even bilateral stenting may prove inadequate. Stents used in ERCP are either plastic or self-expandable metallic stents (SEMS). Though plastic stents show some advantages over SEMS in terms of removability and possibility to adapt to a biliary tree which allows potential reinterventions, SEMS are better in terms of patency, lower complications number, and success of drainage. Besides ERCP, echo-endoscopic drainage is also an option, especially when ERCP approach has not yielded a successful drainage. The aim of this study was to show the potential of ERCP stenting in CCA treatment, its possible pitfalls, and the need to consider multiple levels of ERCP-related care.

Keywords

Cholangiocarcinoma (CCA) / endoscopic stenting / biliary drainage / self-expandable metallic stents (SEMS)

References

[1] Saha SK,Fuchs CS.Forty-year trends in cholangiocarcinoma incidence in the U.S.: intrahepatic disease on the rise.Oncologist2016;21:594-9 PMCID:PMC4861366

[2] Cardinale V,Carpino G.Cholangiocarcinoma: increasing burden of classifications.Hepatobiliary Surg Nutr2013;2:272-80

[3] Brunt E,Clavien PA.cHCC-CCA: consensus terminology for primary liver carcinomas with both hepatocytic and cholangiocytic differentation.Hepatology2018;68:113-26

[4] Guest RV,Kendall TJ.Cell lineage tracing reveals a biliary origin of intrahepatic cholangiocarcinoma.Cancer Res2014;74:1005-10 PMCID:PMC3929349

[5] Affo S,Brundu F.Promotion of cholangiocarcinoma growth by diverse cancer-associated fibroblast subpopulations.Cancer Cell2021;39:866-82.e11 PMCID:PMC8241235

[6] Talabnin K,Kumagai T.Ganglioside GM2: a potential biomarker for cholangiocarcinoma.J Int Med Res2020;48:300060520903216 PMCID:PMC7375732

[7] Jarnagin W.Hilar cholangiocarcinoma: diagnosis and staging.HPB2005;7:244-51 PMCID:PMC2043098

[8] Blechacz B,Roskams T.Clinical diagnosis and staging of cholangiocarcinoma.Nat Rev Gastroenterol Hepatol2011;8:512-22 PMCID:PMC3331791

[9] Burak K,Pasha TM,Petz J.Incidence and risk factors for cholangiocarcinoma in primary sclerosing cholangitis.Am J Gastroenterol2004;99:523-6

[10] Esnaola NF,Karachristos A,Camp ER.Evaluation and management of intrahepatic and extrahepatic cholangiocarcinoma.Cancer2016;122:1349-69

[11] Tantau AI,Pop A.Extrahepatic cholangiocarcinoma: current status of endoscopic approach and additional therapies.World J Hepatol2021;13:166-86 PMCID:PMC7934015

[12] Banales JM,Lamarca A.Cholangiocarcinoma 2020: the next horizon in mechanisms and management.Nat Rev Gastroenterol Hepatol2020;17:557-88 PMCID:PMC7447603

[13] Khan SA,Ladep NG.Rising trends in cholangiocarcinoma: is the ICD classification system misleading us?.J Hepatol2012;56:848-54

[14] Bertuccio P,Carioli G.Global trends in mortality from intrahepatic and extrahepatic cholangiocarcinoma.J Hepatol2019;71:104-14

[15] Ramadori G.Effects of systemic chemotherapy on the liver.Ann Hepatol2010;9:133-43

[16] Pavlidis ET.Pathophysiological consequences of obstructive jaundice and perioperative management.Hepatobiliary Pancreat Dis Int2018;17:17-21

[17] Golse N,Mazzotta A.Personalized preoperative nomograms predicting postoperative risks after resection of perihilar cholangiocarcinoma.World J Surg2020;44:3449-60

[18] Rizvi S,Hallemeier CL,Gores GJ.Cholangiocarcinoma - evolving concepts and therapeutic strategies.Nat Rev Clin Oncol2018;15:95-111 PMCID:PMC5819599

[19] Brandi G,Pantaleo MA.GICOCholangiocarcinoma: current opinion on clinical practice diagnostic and therapeutic algorithms: a review of the literature and a long-standing experience of a referral center.Dig Liver Dis2016;48:231-41

[20] Kurahara H,Mataki Y.Preoperative biliary drainage-related inflammation is associated with shorter survival in biliary tract cancer patients.Int J Clin Oncol2016;21:934-9

[21] Szary NM.Complications of endoscopic retrograde cholangiopancreatography: how to avoid and manage them.Gastroenterol Hepatol2013;9:496-504 PMCID:PMC3980992

[22] Liu F,Wei Y.Preoperative biliary drainage before resection for hilar cholangiocarcinoma: whether or not? a systematic review .Dig Dis Sci2011;56:663-72

[23] Tringali A,Rota M,Mutignani M.Covered vs. uncovered self-expandable metal stents for malignant distal biliary strictures: a systematic review and meta-analysis.Endoscopy2018;50:631-41

[24] Hilscher MB,Carey EJ,Lindor KD.Dominant strictures in primary sclerosing cholangitis: a multicenter survey of clinical definitions and practices.Hepatol Commun2018;2:836-44 PMCID:PMC6049068

[25] Bowlus CL,Lindor KD.AGA clinical practice update on surveillance for hepatobiliary cancers in patients with primary sclerosing cholangitis: expert review.Clin Gastroenterol Hepatol2019;17:2416-22

[26] Rupp C,Bruckner T.Effect of scheduled endoscopic dilatation of dominant strictures on outcome in patients with primary sclerosing cholangitis.Gut2019;68:2170-8 PMCID:PMC6872453

[27] Miura F,Wada K.Prognostic impact of type of preoperative biliary drainage in patients with distal cholangiocarcinoma.Am J Surg2017;214:256-61

[28] George C,Cast JE.Interventional radiology in the management of malignant biliary obstruction.World J Gastrointest Oncol2010;2:146-50 PMCID:PMC2999171

[29] Paik WH,Hwang JH.Palliative treatment with self-expandable metallic stents in patients with advanced type III or IV hilar cholangiocarcinoma: a percutaneous versus endoscopic approach.Gastrointest Endosc2009;69:55-62

[30] Zhou WZ,Yang ZQ.Percutaneous stent placement for malignant hilar biliary obstruction: side-by-side versus stent-in-stent technique.BMC Gastroenterol2020;20:174 PMCID:PMC7275544

[31] Gouma DJ.Multicentre European study of preoperative biliary drainage for hilar cholangiocarcinoma (Br J Surg 2013; 100: 274-283).Br J Surg2013;100:283-4

[32] Zhao XQ,Jiang K,Zhang WZ.Comparison of percutaneous transhepatic biliary drainage and endoscopic biliary drainage in the management of malignant biliary tract obstruction: a meta-analysis.Dig Endosc2015;27:137-45

[33] Inamdar S,Bhalla R,Trindade AJ.Comparison of adverse events for endoscopic vs percutaneous biliary drainage in the treatment of malignant biliary tract obstruction in an inpatient national cohort.JAMA Oncol2016;2:112-7

[34] Farges O,Fuks D.Multicentre European study of preoperative biliary drainage for hilar cholangiocarcinoma.Br J Surg2013;100:274-83

[35] Mocan T,Mois E.Endoscopic or percutaneous biliary drainage in hilar cholangiocarcinoma: when and how?.World J Gastrointest Oncol2021;13:2050-63 PMCID:PMC8713328

[36] Tang Z,Meng W.Best option for preoperative biliary drainage in Klatskin tumor: a systematic review and meta-analysis.Medicine2017;96:e8372 PMCID:PMC5671862

[37] Liu JG,Wang J.Endoscopic biliary drainage versus percutaneous transhepatic biliary drainage in patients with resectable hilar cholangiocarcinoma: a systematic review and meta-analysis.J Laparoendosc Adv Surg Tech A2018;28:1053-60

[38] Al Mahjoub A,Fohlen A.Preoperative biliary drainage in patients with resectable perihilar cholangiocarcinoma: is percutaneous transhepatic biliary drainage safer and more effective than endoscopic biliary drainage?.J Vasc Interv Radiol2017;28:576-82

[39] Takahashi Y,Nishio H,Igami T.Percutaneous transhepatic biliary drainage catheter tract recurrence in cholangiocarcinoma.Br J Surg2010;97:1860-6

[40] Vogel A,Edeline J.ESMO Guidelines CommitteeBiliary tract cancer: ESMO Clinical Practice Guideline for diagnosis, treatment and follow-up.Ann Oncol2023;34:127-40

[41] Xia MX,Wu J.The risk of acute cholangitis after endoscopic stenting for malignant hilar strictures: a large comprehensive study.J Gastroenterol Hepatol2020;35:1150-7

[42] Prachayakul V,Aswakul P.Clinical characteristics and treatment outcomes of patients with unresectable cholangiocarcinoma in Thailand: are there differences dependent on stent type?.Asian Pac J Cancer Prev2013;14:529-32

[43] Moole H,Cashman M.Are self-expandable metal stents superior to plastic stents in palliating malignant distal biliary strictures?.Med J Armed Forces India2017;73:42-8 PMCID:PMC5221362

[44] Squadroni M,Gatta G,Beretta G.Cholangiocarcinoma.Crit Rev Oncol Hematol2017;116:11-31

[45] Zaydfudim VM,Nagorney DM.Hilar cholangiocarcinoma.Surg Oncol Clin N Am2014;23:247-63

[46] Boškoski I,Tringali A.Personalized endoscopy in complex malignant hilar biliary strictures.J Pers Med2021;11:78 PMCID:PMC7911877

[47] Dumonceau JM,Papanikolaou IS.Endoscopic biliary stenting: indications, choice of stents, and results: European society of gastrointestinal endoscopy (ESGE) clinical guideline - updated October 2017.Endoscopy2018;50:910-30

[48] Sofi AA,Das A.Radiofrequency ablation combined with biliary stent placement versus stent placement alone for malignant biliary strictures: a systematic review and meta-analysis.Gastrointest Endosc2018;87:944-51.e1

[49] Smith AC,Russell RC,Cotton PB.Randomised trial of endoscopic stenting versus surgical bypass in malignant low bileduct obstruction.Lancet1994;344:1655-60

[50] Uppal DS.Advances in endoscopic retrograde cholangiopancreatography for the treatment of cholangiocarcinoma.World J Gastrointest Endosc2015;7:675-87 PMCID:PMC4482827

[51] Vienne A,Gouya H.Prediction of drainage effectiveness during endoscopic stenting of malignant hilar strictures: the role of liver volume assessment.Gastrointest Endosc2010;72:728-35

[52] Kerdsirichairat T,Attam R.Endoscopic drainage of > 50% of liver in malignant hilar biliary obstruction using metallic or fenestrated plastic stents.Clin Transl Gastroenterol2017;8:e115 PMCID:PMC5587843

[53] Neu B,von Delius S.Endoscopic rendez-vous reconstruction of complete biliary obstruction.Dig Liver Dis2017;49:769-72

[54] Mansour JC,Crane CH,Nagino M.Hilar cholangiocarcinoma: expert consensus statement.HPB2015;17:691-9 PMCID:PMC4527854

[55] Keswani RN,O'Dwyer LC.Association between endoscopist and center endoscopic retrograde cholangiopancreatography volume with procedure success and adverse outcomes: a systematic review and meta-analysis.Clin Gastroenterol Hepatol2017;15:1866-75.e3

[56] Gwon DI,Sung KB.Percutaneous biliary metallic stent placement in patients with unilobar portal vein occlusion caused by advanced hilar malignancy: outcome of unilateral versus bilateral stenting.AJR Am J Roentgenol2011;197:795-801

[57] Masselli G,Vecchioli A.MR imaging and MR cholangiopancreatography in the preoperative evaluation of hilar cholangiocarcinoma: correlation with surgical and pathologic findings.Eur Radiol2008;18:2213-21

[58] Yasuda I,Moriwaki H.Unilateral versus bilateral endoscopic biliary stenting for malignant hilar biliary strictures.Dig Endosc2013;25 Suppl 2:81-5

[59] Iwano H,Ishigaki N.Unilateral versus bilateral drainage using self-expandable metallic stent for unresectable hilar biliary obstruction.Dig Endosc2011;23:43-8

[60] Mukai T,Nakashima M.Metallic stents are more efficacious than plastic stents in unresectable malignant hilar biliary strictures: a randomized controlled trial.J Hepatobiliary Pancreat Sci2013;20:214-22

[61] Polydorou AA,Romanos AA.A comparison of right versus left hepatic duct endoprosthesis insertion in malignant hilar biliary obstruction.Endoscopy1989;21:266-71

[62] De Palma GD,Siciliano S,Catanzano C.Unilateral versus bilateral endoscopic hepatic duct drainage in patients with malignant hilar biliary obstruction: results of a prospective, randomized, and controlled study.Gastrointest Endosc2001;53:547-53

[63] Aghaie Meybodi M,Nanavati J.Unilateral versus bilateral endoscopic stenting in patients with unresectable malignant hilar obstruction: a systematic review and meta-analysis.Endosc Int Open2020;8:E281-90 PMCID:PMC7035140

[64] Staub J,Murphy M.Unilateral versus bilateral hilar stents for the treatment of cholangiocarcinoma: a multicenter international study.Ann Gastroenterol2020;33:202-9 PMCID:PMC7049245

[65] Lee TH,Park SH.Biliary stenting for hilar malignant biliary obstruction.Dig Endosc2020;32:275-86

[66] Nomura T,Hatakeyama K.Cholangitis after endoscopic biliary drainage for hilar lesions.Hepatogastroenterology1997;44:1267-70

[67] Takahashi E,Sato T.Biliary drainage strategy of unresectable malignant hilar strictures by computed tomography volumetry.World J Gastroenterol2015;21:4946-53 PMCID:PMC4408467

[68] Singh V,Verma GR,Gulati M.Contrast-free unilateral endoscopic palliation in malignant hilar biliary obstruction: new method.J Gastroenterol Hepatol2004;19:589-92

[69] Sud R,Choudhary NS,Jain PK.Air cholangiogram is not inferior to dye cholangiogram for malignant hilar biliary obstruction: a randomized study of efficacy and safety.Indian J Gastroenterol2014;33:537-42

[70] Chang WH,Haber GB.Outcome in patients with bifurcation tumors who undergo unilateral versus bilateral hepatic duct drainage.Gastrointest Endosc1998;47:354-62

[71] Liberato MJ.Endoscopic stenting for hilar cholangiocarcinoma: efficacy of unilateral and bilateral placement of plastic and metal stents in a retrospective review of 480 patients.BMC Gastroenterol2012;12:103 PMCID:PMC3476445

[72] Naitoh I,Nakazawa T.Unilateral versus bilateral endoscopic metal stenting for malignant hilar biliary obstruction.J Gastroenterol Hepatol2009;24:552-7

[73] Lee TH,Moon JH.Bilateral versus unilateral placement of metal stents for inoperable high-grade malignant hilar biliary strictures: a multicenter, prospective, randomized study (with video).Gastrointest Endosc2017;86:817-27

[74] Ashat M,Klair JS,Murali AR.Bilateral vs unilateral placement of metal stents for inoperable high-grade hilar biliary strictures: a systemic review and meta-analysis.World J Gastroenterol2019;25:5210-9 PMCID:PMC6747295

[75] Chen ZK,Xu YS.Unilateral versus side-by-side metal stenting for malignant hilar biliary obstruction: a meta-analysis.J Laparoendosc Adv Surg Tech A2021;31:203-9

[76] Puli SR,Pamulaparthy SR.Bilateral and unilateral stenting for malignant hilar obstruction: a systematic review and meta-analysis.Indian J Gastroenterol2013;32:355-62

[77] Almadi MA,Martel M.Plastic vs. self-expandable metal stents for palliation in malignant biliary obstruction: a series of meta-analyses.Am J Gastroenterol2017;112:260-73

[78] Coelen RJS,Wiggers JK.Endoscopic versus percutaneous biliary drainage in patients with resectable perihilar cholangiocarcinoma: a multicentre, randomised controlled trial.Lancet Gastroenterol Hepatol2018;3:681-90

[79] Zorrón Pu L,Bernardo WM.Endoscopic stenting for inoperable malignant biliary obstruction: a systematic review and meta-analysis.World J Gastroenterol2015;21:13374-85 PMCID:PMC4679772

[80] Sawas T,Parsi MA.Self-expandable metal stents versus plastic stents for malignant biliary obstruction: a meta-analysis.Gastrointest Endosc2015;82:256-67.e7

[81] Hong WD,Wu WZ,Chen XR.Metal versus plastic stents for malignant biliary obstruction: an update meta-analysis.Clin Res Hepatol Gastroenterol2013;37:496-500

[82] Kwon CI.Mechanisms of biliary plastic stent occlusion and efforts at prevention.Clin Endosc2016;49:139-46 PMCID:PMC4821514

[83] Schmassmann A,Knuchel J,Fehr HF.Wallstents versus plastic stents in malignant biliary obstruction: effects of stent patency of the first and second stent on patient compliance and survival.Am J Gastroenterol1996; 91:654-9

[84] Weber A,Wagenpfeil S,Prinz C.Self-expanding metal stents versus polyethylene stents for palliative treatment in patients with advanced pancreatic cancer.Pancreas2009;38:e7-e12

[85] Walter D,Groenen MJ.Cost efficacy of metal stents for palliation of extrahepatic bile duct obstruction in a randomized controlled trial.Gastroenterology2015;149:130-8

[86] Speer AG,MacRae KD.Endoscopic management of malignant biliary obstruction: stents of 10 French gauge are preferable to stents of 8 French gauge.Gastrointest Endosc1988;34:412-7

[87] Luigiano C,Cennamo V.A comparison of uncovered metal stents for the palliation of patients with malignant biliary obstruction: nitinol vs. stainless steel.Dig Liver Dis2012;44:128-33

[88] Perdue DG,DiSario JA.ERCP Outcome Study ERCOST GroupPlastic versus self-expanding metallic stents for malignant hilar biliary obstruction: a prospective multicenter observational cohort study.J Clin Gastroenterol2008;42:1040-6

[89] Yuan TW,Wang SB.Comparison of plastic stents with self-expandable metal stents in palliative treatment of malignant biliary obstruction: a meta-analysis.Eur Rev Med Pharmacol Sci2017;21:2847-57

[90] Xia MX,Cai XB.Comparison of endoscopic bilateral metal stent drainage with plastic stents in the palliation of unresectable hilar biliary malignant strictures: Large multicenter study.Dig Endosc2021;33:179-89

[91] Ridtitid W,Janchai A,Treeprasertsuk S.Outcome of second interventions for occluded metallic stents in patients with malignant biliary obstruction.Surg Endosc2010;24:2216-20

[92] Hong W,Zhu Q.Endoscopic stenting for malignant hilar biliary obstruction: should it be metal or plastic and unilateral or bilateral?.Eur J Gastroenterol Hepatol2013;25:1105-12

[93] Park CH,Jung JH,Kim JH.Comparative efficacy of various stents for palliation in patients with malignant extrahepatic biliary obstruction: a systematic review and network meta-analysis.J Pers Med2021;11:86 PMCID:PMC7912345

[94] Saleem A,Murad MH.Meta-analysis of randomized trials comparing the patency of covered and uncovered self-expandable metal stents for palliation of distal malignant bile duct obstruction.Gastrointest Endosc2011;74:321-7.e1

[95] Moole H,Cashman M.Covered versus uncovered self-expandable metal stents for malignant biliary strictures: a meta-analysis and systematic review.Indian J Gastroenterol2016;35:323-30

[96] Coté GA,Ansstas M.Risk of post-ERCP pancreatitis with placement of self-expandable metallic stents.Gastrointest Endosc2010;72:748-54

[97] Nakai Y,Togawa O.New method of covered wallstents for distal malignant biliary obstruction to reduce early stent-related complications based on characteristics.Dig Endosc2011;23:49-55

[98] Sogabe Y,Honjo H.Tumor invasion to the arteries feeding the gallbladder as a novel risk factor for cholecystitis after metallic stent placement in distal malignant biliary obstruction.Dig Endosc2018;30:380-7

[99] Kawakubo K,Nakai Y.Risk factors for pancreatitis following transpapillary self-expandable metal stent placement.Surg Endosc2012;26:771-6

[100] Costamagna G.Can we insert a covered stent, partially or not, in case of hilar biliary stenosis?.Endosc Int Open2017;5:E1218-9 PMCID:PMC5699906

[101] Kitamura K,Ishii Y,Nomoto T.Side-by-side partially covered self-expandable metal stent placement for malignant hilar biliary obstruction.Endosc Int Open2017;5:E1211-7 PMCID:PMC5699902

[102] Inoue T,Naitoh I.Feasibility of the placement of a novel 6-mm diameter threaded fully covered self-expandable metal stent for malignant hilar biliary obstructions (with videos).Gastrointest Endosc2016;84:352-7

[103] Yoshida T,Imaoka H.Benefits of side-by-side deployment of 6-mm covered self-expandable metal stents for hilar malignant biliary obstructions.J Hepatobiliary Pancreat Sci2016;23:548-55

[104] Lee TH,Moon JH.Technical tips and issues of biliary stenting, focusing on malignant hilar obstruction.Minerva Gastroenterol Dietol2014;60:135-49

[105] Dumas R,Buckley M.Endoscopic bilateral metal stent placement for malignant hilar stenoses: identification of optimal technique.Gastrointest Endosc2000;51:334-8

[106] Chennat J.Initial performance profile of a new 6F self-expanding metal stent for palliation of malignant hilar biliary obstruction.Gastrointest Endosc2010;72:632-6

[107] Fukasawa M,Shindo H,Sato T.Endoscopic biliary stenting for unresectable malignant hilar obstruction.Clin J Gastroenterol2017;10:485-90

[108] Moon JH,Kogure H,Isayama H.Topic controversies in the endoscopic management of malignant hilar strictures using metal stent: side-by-side versus stent-in-stent techniques.J Hepatobiliary Pancreat Sci2015;22:650-6

[109] Kawamoto H,Fujii M.Endoscopic 3-branched partial stent-in-stent deployment of metallic stents in high-grade malignant hilar biliary stricture (with videos).Gastrointest Endosc2007;66:1030-7

[110] Naitoh I,Nakazawa T.Side-by-side versus stent-in-stent deployment in bilateral endoscopic metal stenting for malignant hilar biliary obstruction.Dig Dis Sci2012;57:3279-85

[111] Lee TH,Choi JH.Prospective comparison of endoscopic bilateral stent-in-stent versus stent-by-stent deployment for inoperable advanced malignant hilar biliary stricture.Gastrointest Endosc2019;90:222-30

[112] Ishigaki K,Nakai Y.Retrospective comparative study of side-by-side and stent-in-stent metal stent placement for hilar malignant biliary obstruction.Dig Dis Sci2020;65:3710-8

[113] Hong W,Zhu Q,Pan J.Bilateral stenting methods for hilar biliary obstructions.Clinics2014;69:647-52 PMCID:PMC4192403

[114] Chen L,Li DL.Side-by-side versus stent-in-stent bilateral stenting for malignant hilar biliary obstruction: a meta-analysis.Wideochir Inne Tech Maloinwazyjne2022;17:279-88 PMCID:PMC9186079

[115] Shah T,Haque M,Fisher D.Management of occluded metal stents in malignant biliary obstruction: similar outcomes with second metal stents compared to plastic stents.Dig Dis Sci2012;57:2765-73 PMCID:PMC3920578

[116] Inoue T,Okumura F.Reintervention for stent occlusion after bilateral self-expandable metallic stent placement for malignant hilar biliary obstruction.Dig Endosc2016;28:731-7

[117] Anderson DJ,McDonald JR.Infectious complications following endoscopic retrograde cholangiopancreatography: an automated surveillance system for detecting postprocedure bacteremia.Am J Infect Control2008;36:592-4

[118] Andriulli A,Napolitano G.Incidence rates of post-ERCP complications: a systematic survey of prospective studies.Am J Gastroenterol2007;102:1781-8

[119] Giovannini M,Pesenti C,Lelong B.Endoscopic ultrasound-guided bilioduodenal anastomosis: a new technique for biliary drainage.Endoscopy2001;33:898-900

[120] Artifon ELA,Otoch JP,Itoi T.EUS-guided biliary drainage: a review article.JOP J Pancreas2012;13:7-17

[121] Baniya R,Madala S,Shaik Mohammed T.Endoscopic ultrasound-guided biliary drainage versus percutaneous transhepatic biliary drainage after failed endoscopic retrograde cholangiopancreatography: a meta-analysis.Clin Exp Gastroenterol2017;10:67-74 PMCID:PMC5384693

[122] Park DH,Lee SS,Lee SK.EUS-guided biliary drainage with transluminal stenting after failed ERCP: predictors of adverse events and long-term results.Gastrointest Endosc2011;74:1276-84

[123] Teoh AYB,Kida M.Consensus guidelines on the optimal management in interventional EUS procedures: results from the Asian EUS group RAND/UCLA expert panel.Gut2018;67:1209-28

[124] Horaguchi J,Noda Y.Endosonography-guided biliary drainage in cases with difficult transpapillary endoscopic biliary drainage.Dig Endosc2009;21:239-44

[125] Bories E,Caillol F,Giovannini M.Transgastric endoscopic ultrasonography-guided biliary drainage: results of a pilot study.Endoscopy2007;39:287-91

[126] Park DH,Oh J.EUS-guided biliary drainage with one-step placement of a fully covered metal stent for malignant biliary obstruction: a prospective feasibility study.Am J Gastroenterol2009;104:2168-74

[127] Perez-Miranda M,Diez-Redondo P.Endosonography-guided cholangiopancreatography as a salvage drainage procedure for obstructed biliary and pancreatic ducts.World J Gastrointest Endosc2010;2:212-22 PMCID:PMC2998937

[128] Park DH,Eum J.EUS-guided hepaticogastrostomy with a fully covered metal stent as the biliary diversion technique for an occluded biliary metal stent after a failed ERCP (with videos).Gastrointest Endosc2010;71:413-9

[129] Kawakubo K,Kato H.Multicenter retrospective study of endoscopic ultrasound-guided biliary drainage for malignant biliary obstruction in Japan.J Hepatobiliary Pancreat Sci2014;21:328-34

[130] Ogura T,Onda S.Endoscopic ultrasound-guided biliary drainage for right hepatic bile duct obstruction: novel technical tips.Endoscopy2015;47:72-5

[131] Park DH.Endoscopic ultrasound-guided biliary drainage of hilar biliary obstruction.J Hepatobiliary Pancreat Sci2015;22:664-8

[132] Ogura T,Takagi W.Clinical utility of endoscopic ultrasound-guided biliary drainage as a rescue of re-intervention procedure for high-grade hilar stricture.J Gastroenterol Hepatol2017;32:163-8

[133] Kongkam P,Rerknimitr R.Combination of endoscopic retrograde cholangiopancreatography and endoscopic ultrasonography-guided biliary drainage in malignant hilar biliary obstruction.Dig Endosc2019;31 Suppl 1:50-4

[134] Nam K,Lee TH.Patient perception and preference of EUS-guided drainage over percutaneous drainage when endoscopic transpapillary biliary drainage fails: an international multicenter survey.Endosc Ultrasound2018;7:48-55 PMCID:PMC5838728

[135] Chamberlain RS.Hilar cholangiocarcinoma: a review and commentary.Ann Surg Oncol2000;7:55-66

[136] Dondossola D,Grossi F,Foschi D.Practical review for diagnosis and clinical management of perihilar cholangiocarcinoma.World J Gastroenterol2020;26:3542-61 PMCID:PMC7366054

[137] Zoepf T,Arnold JC,Riemann JF.Palliation of nonresectable bile duct cancer: improved survival after photodynamic therapy.Am J Gastroenterol2005;100:2426-30

[138] Larghi A,Tringali A,Rizzatti G.Endoscopic radiofrequency biliary ablation treatment: a comprehensive review.Dig Endosc2019;31:245-55

[139] Nayar MK,Bekkali NLH.Novel temperature-controlled RFA probe for treatment of blocked metal biliary stents in patients with pancreaticobiliary cancers: initial experience.Endosc Int Open2018;6:E513-7 PMCID:PMC5906122

[140] Skowronek J.Brachytherapy in the treatment of bile duct cancer - a tough challenge.J Contemp Brachytherapy2017;9:187-95 PMCID:PMC5437079

[141] Mukewar S,Baron TH.Endoscopically inserted nasobiliary catheters for high dose-rate brachytherapy as part of neoadjuvant therapy for perihilar cholangiocarcinoma.Endoscopy2015;47:878-83

[142] Agostinis P,Cengel KA.Photodynamic therapy of cancer: an update.CA Cancer J Clin2011;61:250-81 PMCID:PMC3209659

[143] Feisthammel J,Hoffmeister A.Palliative endoscopic treatment options in malignancies of the biliopancreatic system.Viszeralmedizin2014;30:238-43 PMCID:PMC4513803

[144] Ortner ME,Berr F.Successful photodynamic therapy for nonresectable cholangiocarcinoma: a randomized prospective study.Gastroenterology2003;125:1355-63

[145] Li Z,Xiao H.Long-term results of ERCP- or PTCS-directed photodynamic therapy for unresectable hilar cholangiocarcinoma.Surg Endosc2021;35:5655-64 PMCID:PMC8437910

[146] Lee TY,Shim CS.Photodynamic therapy in patients with advanced hilar cholangiocarcinoma: percutaneous cholangioscopic versus peroral transpapillary approach.Photomed Laser Surg2016;34:150-6