WHAT SHOULD WE DO IN CASES WITH ENDOSCOPIC DIAGNOSIS OF PROGRESSION OF PERIHILAR CHOLANGIOCARCINOMA?

Abstract

An accurate diagnosis of the extent of progression of hilar cholangiocarcinoma should be required in cases where radical hepatectomy will be performed. However, since the endoscopic examination was invasive and traumatic, it would be necessary to discuss the extent of excision of the liver corresponding to the extent of tumor progression using radiographic examination in advance. There are many endoscopic examinations such as endoscopic ultrasonography (EUS), endoscopic retrograde cholangiopancreatography (ERCP) and related procedures including cholangioscopy, and we have to accurately diagnose the extent of tumor progression by integrating the results of various examinations. EUS is useful for diagnosing the extent of tumor spread in the extrahepatic bile ducts, and evaluation by cholangiography is indispensable to assess the Bismuth classification. Furthermore, information on tumor progression could be enhanced by adding intraductal ultrasonography (IDUS) and mapping biopsy, and cholangioscopic images could directly make a difference in the macroscopic diagnosis of the extent of tumor spread in bile duct epithelia.