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Erschienen in: Die Gastroenterologie 1/2023

04.01.2023 | Photodynamische Therapie | Schwerpunkt

Endoskopisch gesteuerte Diagnostik und Therapie von Cholangiokarzinomen

verfasst von: Prof. Dr. med. Ulrike Denzer, Prof. Dr. med. Alexander Dechêne

Erschienen in: Die Gastroenterologie | Ausgabe 1/2023

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Zusammenfassung

Cholangiokarzinome sind insgesamt seltene gastrointestinale Tumoren, die nur in der Minderzahl kurativ behandelbar sind. Klassifiziert werden sie nach extra- oder intrahepatischer Position, wobei Symptome eher spät im Krankheitsverlauf auftreten. Zur Art- und Ausbreitungsdiagnostik sind neben Schnittbild-radiologischen Verfahren insbesondere endoskopische Methoden entscheidend, wobei zur Festlegung von Art und Stadium des Tumors häufig ein Mosaik verschiedener Verfahren zusammengesetzt werden muss. Die Gewebegewinnung aus Cholangiokarzinomen ist aufgrund der meist hypozellulären Tumoren herausfordernd. Im (häufigen) Fall einer palliativen Behandlung kommen neben der Systemtherapie verschiedene lokaltherapeutische Verfahren zum Einsatz, die einen positiven Einfluss auf das Überleben selektionierter Patienten haben.
Literatur
1.
Zurück zum Zitat Banales JM, Cardinale V, Carpino G, Marzioni M, Andersen JB, Invernizzi P et al (2016) Expert consensus document: Cholangiocarcinoma: current knowledge and future perspectives consensus statement from the European Network for the Study of Cholangiocarcinoma (ENS-CCA). Nat Rev Gastroenterol Hepatol 13(5):261–280 CrossRef Banales JM, Cardinale V, Carpino G, Marzioni M, Andersen JB, Invernizzi P et al (2016) Expert consensus document: Cholangiocarcinoma: current knowledge and future perspectives consensus statement from the European Network for the Study of Cholangiocarcinoma (ENS-CCA). Nat Rev Gastroenterol Hepatol 13(5):261–280 CrossRef
2.
Zurück zum Zitat Palmer WC, Patel T (2012) Are common factors involved in the pathogenesis of primary liver cancers? A meta-analysis of risk factors for intrahepatic cholangiocarcinoma. J Hepatol 57(1):69–76 CrossRef Palmer WC, Patel T (2012) Are common factors involved in the pathogenesis of primary liver cancers? A meta-analysis of risk factors for intrahepatic cholangiocarcinoma. J Hepatol 57(1):69–76 CrossRef
3.
Zurück zum Zitat Hennedige TP, Neo WT, Venkatesh SK (2014) Imaging of malignancies of the biliary tract- an update. Cancer Imaging 14:14 Hennedige TP, Neo WT, Venkatesh SK (2014) Imaging of malignancies of the biliary tract- an update. Cancer Imaging 14:14
4.
Zurück zum Zitat Nagino M, Hirano S, Yoshitomi H, Aoki T, Uesaka K, Unno M et al (2021) Clinical practice guidelines for the management of biliary tract cancers 2019: The 3rd English edition. J Hepatobiliary Pancreat Sci 28(1):26–54 CrossRef Nagino M, Hirano S, Yoshitomi H, Aoki T, Uesaka K, Unno M et al (2021) Clinical practice guidelines for the management of biliary tract cancers 2019: The 3rd English edition. J Hepatobiliary Pancreat Sci 28(1):26–54 CrossRef
5.
Zurück zum Zitat Bismuth H, Corlette MB (1975) Intrahepatic cholangioenteric anastomosis in carcinoma of the hilus of the liver. Surg Gynecol Obstet 140(2):170–178 Bismuth H, Corlette MB (1975) Intrahepatic cholangioenteric anastomosis in carcinoma of the hilus of the liver. Surg Gynecol Obstet 140(2):170–178
6.
Zurück zum Zitat Rosch T, Meining A, Fruhmorgen S, Zillinger C, Schusdziarra V, Hellerhoff K et al (2002) A prospective comparison of the diagnostic accuracy of ERCP, MRCP, CT, and EUS in biliary strictures. Gastrointest Endosc 55(7):870–876 CrossRef Rosch T, Meining A, Fruhmorgen S, Zillinger C, Schusdziarra V, Hellerhoff K et al (2002) A prospective comparison of the diagnostic accuracy of ERCP, MRCP, CT, and EUS in biliary strictures. Gastrointest Endosc 55(7):870–876 CrossRef
7.
Zurück zum Zitat Park MS, Kim TK, Kim KW, Park SW, Lee JK, Kim JS et al (2004) Differentiation of extrahepatic bile duct cholangiocarcinoma from benign stricture: findings at MRCP versus ERCP. Radiology 233(1):234–240 CrossRef Park MS, Kim TK, Kim KW, Park SW, Lee JK, Kim JS et al (2004) Differentiation of extrahepatic bile duct cholangiocarcinoma from benign stricture: findings at MRCP versus ERCP. Radiology 233(1):234–240 CrossRef
8.
Zurück zum Zitat Mohamadnejad M, DeWitt JM, Sherman S, LeBlanc JK, Pitt HA, House MG et al (2011) Role of EUS for preoperative evaluation of cholangiocarcinoma: a large single-center experience. Gastrointest Endosc 73(1):71–78 CrossRef Mohamadnejad M, DeWitt JM, Sherman S, LeBlanc JK, Pitt HA, House MG et al (2011) Role of EUS for preoperative evaluation of cholangiocarcinoma: a large single-center experience. Gastrointest Endosc 73(1):71–78 CrossRef
9.
Zurück zum Zitat Malikowski T, Levy MJ, Gleeson FC, Storm AC, Vargas EJ, Topazian MD et al (2020) Endoscopic ultrasound/Fine needle aspiration is effective for lymph node staging in patients with cholangiocarcinoma. Hepatology 72(3):940–948 (Sep) CrossRef Malikowski T, Levy MJ, Gleeson FC, Storm AC, Vargas EJ, Topazian MD et al (2020) Endoscopic ultrasound/Fine needle aspiration is effective for lymph node staging in patients with cholangiocarcinoma. Hepatology 72(3):940–948 (Sep) CrossRef
10.
Zurück zum Zitat Tamada K, Nagai H, Yasuda Y, Tomiyama T, Ohashi A, Wada S et al (2001) Transpapillary intraductal US prior to biliary drainage in the assessment of longitudinal spread of extrahepatic bile duct carcinoma. Gastrointest Endosc 53(3):300–307 CrossRef Tamada K, Nagai H, Yasuda Y, Tomiyama T, Ohashi A, Wada S et al (2001) Transpapillary intraductal US prior to biliary drainage in the assessment of longitudinal spread of extrahepatic bile duct carcinoma. Gastrointest Endosc 53(3):300–307 CrossRef
11.
Zurück zum Zitat Vazquez-Sequeiros E, Baron TH, Clain JE, Gostout CJ, Norton ID, Petersen BT et al (2002) Evaluation of indeterminate bile duct strictures by intraductal US. Gastrointest Endosc 56(3):372–379 CrossRef Vazquez-Sequeiros E, Baron TH, Clain JE, Gostout CJ, Norton ID, Petersen BT et al (2002) Evaluation of indeterminate bile duct strictures by intraductal US. Gastrointest Endosc 56(3):372–379 CrossRef
12.
Zurück zum Zitat Heinzow HS, Kammerer S, Rammes C, Wessling J, Domagk D, Meister T (2014) Comparative analysis of ERCP, IDUS, EUS and CT in predicting malignant bile duct strictures. World J Gastroenterol 20(30):10495–10503 CrossRef Heinzow HS, Kammerer S, Rammes C, Wessling J, Domagk D, Meister T (2014) Comparative analysis of ERCP, IDUS, EUS and CT in predicting malignant bile duct strictures. World J Gastroenterol 20(30):10495–10503 CrossRef
13.
Zurück zum Zitat Stassen PMC, de Jonge PJF, Webster GJM, Ellrichmann M, Dormann AJ, Udd M et al (2021) Clinical practice patterns in indirect peroral cholangiopancreatoscopy: outcome of a European survey. Endosc Int Open 9(11):E1704–E1711 CrossRef Stassen PMC, de Jonge PJF, Webster GJM, Ellrichmann M, Dormann AJ, Udd M et al (2021) Clinical practice patterns in indirect peroral cholangiopancreatoscopy: outcome of a European survey. Endosc Int Open 9(11):E1704–E1711 CrossRef
14.
Zurück zum Zitat Albert JG, Friedrich-Rust M, Elhendawy M, Trojan J, Zeuzem S, Sarrazin C (2011) Peroral cholangioscopy for diagnosis and therapy of biliary tract disease using an ultra-slim gastroscope. Endoscopy 43(11):1004–1009 CrossRef Albert JG, Friedrich-Rust M, Elhendawy M, Trojan J, Zeuzem S, Sarrazin C (2011) Peroral cholangioscopy for diagnosis and therapy of biliary tract disease using an ultra-slim gastroscope. Endoscopy 43(11):1004–1009 CrossRef
15.
Zurück zum Zitat de Oliveira P, de Moura DTH, Ribeiro IB, Bazarbashi AN, Franzini TAP, Dos Santos MEL et al (2020) Efficacy of digital single-operator cholangioscopy in the visual interpretation of indeterminate biliary strictures: a systematic review and meta-analysis. Surg Endosc 34(8):3321–3329 CrossRef de Oliveira P, de Moura DTH, Ribeiro IB, Bazarbashi AN, Franzini TAP, Dos Santos MEL et al (2020) Efficacy of digital single-operator cholangioscopy in the visual interpretation of indeterminate biliary strictures: a systematic review and meta-analysis. Surg Endosc 34(8):3321–3329 CrossRef
16.
Zurück zum Zitat Stassen PMC, Goodchild G, de Jonge PJF, Erler NS, Anderloni A, Cennamo V et al (2021) Diagnostic accuracy and interobserver agreement of digital single-operator cholangioscopy for indeterminate biliary strictures. Gastrointest Endosc 94(6):1059–1068 CrossRef Stassen PMC, Goodchild G, de Jonge PJF, Erler NS, Anderloni A, Cennamo V et al (2021) Diagnostic accuracy and interobserver agreement of digital single-operator cholangioscopy for indeterminate biliary strictures. Gastrointest Endosc 94(6):1059–1068 CrossRef
17.
Zurück zum Zitat Heimbach JK, Sanchez W, Rosen CB, Gores GJ (2011) Trans-peritoneal fine needle aspiration biopsy of hilar cholangiocarcinoma is associated with disease dissemination. HPB (Oxford) 13(5):356–360 CrossRef Heimbach JK, Sanchez W, Rosen CB, Gores GJ (2011) Trans-peritoneal fine needle aspiration biopsy of hilar cholangiocarcinoma is associated with disease dissemination. HPB (Oxford) 13(5):356–360 CrossRef
18.
Zurück zum Zitat Draganov PV, Chauhan S, Wagh MS, Gupte AR, Lin T, Hou W et al (2012) Diagnostic accuracy of conventional and cholangioscopy-guided sampling of indeterminate biliary lesions at the time of ERCP: a prospective, long-term follow-up study. Gastrointest Endosc 75(2):347–353 CrossRef Draganov PV, Chauhan S, Wagh MS, Gupte AR, Lin T, Hou W et al (2012) Diagnostic accuracy of conventional and cholangioscopy-guided sampling of indeterminate biliary lesions at the time of ERCP: a prospective, long-term follow-up study. Gastrointest Endosc 75(2):347–353 CrossRef
19.
Zurück zum Zitat Korc P, Sherman S (2016) ERCP tissue sampling. Gastrointest Endosc 84(4):557–571 CrossRef Korc P, Sherman S (2016) ERCP tissue sampling. Gastrointest Endosc 84(4):557–571 CrossRef
20.
Zurück zum Zitat Navaneethan U, Njei B, Lourdusamy V, Konjeti R, Vargo JJ, Parsi MA (2015) Comparative effectiveness of biliary brush cytology and intraductal biopsy for detection of malignant biliary strictures: A systematic review and meta-analysis. Gastrointest Endosc 81(1):168–176 CrossRef Navaneethan U, Njei B, Lourdusamy V, Konjeti R, Vargo JJ, Parsi MA (2015) Comparative effectiveness of biliary brush cytology and intraductal biopsy for detection of malignant biliary strictures: A systematic review and meta-analysis. Gastrointest Endosc 81(1):168–176 CrossRef
21.
Zurück zum Zitat Navaneethan U, Hasan MK, Lourdusamy V, Njei B, Varadarajulu S, Hawes RH (2015) Single-operator cholangioscopy and targeted biopsies in the diagnosis of indeterminate biliary strictures: a systematic review. Gastrointest Endosc 82(4):608–614.e2 CrossRef Navaneethan U, Hasan MK, Lourdusamy V, Njei B, Varadarajulu S, Hawes RH (2015) Single-operator cholangioscopy and targeted biopsies in the diagnosis of indeterminate biliary strictures: a systematic review. Gastrointest Endosc 82(4):608–614.e2 CrossRef
22.
Zurück zum Zitat Kulpatcharapong S, Pittayanon R, Kerr SJ, Rerknimitr R (2020) Diagnostic performance of different cholangioscopes in patients with biliary strictures: a systematic review. Endoscopy 52(3):174–185 CrossRef Kulpatcharapong S, Pittayanon R, Kerr SJ, Rerknimitr R (2020) Diagnostic performance of different cholangioscopes in patients with biliary strictures: a systematic review. Endoscopy 52(3):174–185 CrossRef
23.
Zurück zum Zitat Gerges C, Beyna T, Tang RSY, Bahin F, Lau JYW, van Geenen E et al (2020) Digital single-operator peroral cholangioscopy-guided biopsy sampling versus ERCP-guided brushing for indeterminate biliary strictures: a prospective, randomized, multicenter trial (with video). Gastrointest Endosc 91(5):1105–1113 CrossRef Gerges C, Beyna T, Tang RSY, Bahin F, Lau JYW, van Geenen E et al (2020) Digital single-operator peroral cholangioscopy-guided biopsy sampling versus ERCP-guided brushing for indeterminate biliary strictures: a prospective, randomized, multicenter trial (with video). Gastrointest Endosc 91(5):1105–1113 CrossRef
24.
Zurück zum Zitat Vienne A, Hobeika E, Gouya H, Lapidus N, Fritsch J, Choury AD et al (2010) Prediction of drainage effectiveness during endoscopic stenting of malignant hilar strictures: the role of liver volume assessment. Gastrointest Endosc 72(4):728–735 CrossRef Vienne A, Hobeika E, Gouya H, Lapidus N, Fritsch J, Choury AD et al (2010) Prediction of drainage effectiveness during endoscopic stenting of malignant hilar strictures: the role of liver volume assessment. Gastrointest Endosc 72(4):728–735 CrossRef
25.
Zurück zum Zitat Buerlein RCD, Wang AY (2019) Endoscopic retrograde cholangiopancreatography-guided ablation for cholangiocarcinoma. Gastrointest Endosc Clin N Am 29(2):351–367 CrossRef Buerlein RCD, Wang AY (2019) Endoscopic retrograde cholangiopancreatography-guided ablation for cholangiocarcinoma. Gastrointest Endosc Clin N Am 29(2):351–367 CrossRef
26.
Zurück zum Zitat Kang H, Han SY, Cho JH, Kim EJ, Kim DU, Yang JK, Jeon S, Park G, Lee TH (2022) Efficacy and safety of temperature-controlled intraductal radiofrequency ablation in advanced malignant hilar biliary obstruction: A pilot multicenter randomized comparative trial. J Hepatobiliary Pancreat Sci 29(4):469–478. https://​doi.​org/​10.​1002/​jhbp.​1082. Epub 2021 Dec 4. PMID: 34800357 CrossRef Kang H, Han SY, Cho JH, Kim EJ, Kim DU, Yang JK, Jeon S, Park G, Lee TH (2022) Efficacy and safety of temperature-controlled intraductal radiofrequency ablation in advanced malignant hilar biliary obstruction: A pilot multicenter randomized comparative trial. J Hepatobiliary Pancreat Sci 29(4):469–478. https://​doi.​org/​10.​1002/​jhbp.​1082. Epub 2021 Dec 4. PMID: 34800357 CrossRef
27.
Zurück zum Zitat Leggett CL, Gorospe EC, Murad MH, Montori VM, Baron TH, Wang KK (2012) Photodynamic therapy for unresectable cholangiocarcinoma: A comparative effectiveness systematic review and meta-analyses. Photodiagnosis Photodyn Ther 9(3):189–195 CrossRef Leggett CL, Gorospe EC, Murad MH, Montori VM, Baron TH, Wang KK (2012) Photodynamic therapy for unresectable cholangiocarcinoma: A comparative effectiveness systematic review and meta-analyses. Photodiagnosis Photodyn Ther 9(3):189–195 CrossRef
28.
Zurück zum Zitat Lu Y, Liu L, Wu JC, Bie LK, Gong B (2015) Efficacy and safety of photodynamic therapy for unresectable cholangiocarcinoma: A meta-analysis. Clin Res Hepatol Gastroenterol 39(6):718–724 CrossRef Lu Y, Liu L, Wu JC, Bie LK, Gong B (2015) Efficacy and safety of photodynamic therapy for unresectable cholangiocarcinoma: A meta-analysis. Clin Res Hepatol Gastroenterol 39(6):718–724 CrossRef
29.
Zurück zum Zitat Moole H, Tathireddy H, Dharmapuri S, Moole V, Boddireddy R, Yedama P et al (2017) Success of photodynamic therapy in palliating patients with nonresectable cholangiocarcinoma: A systematic review and meta-analysis. World J Gastroenterol 23(7):1278–1288 CrossRef Moole H, Tathireddy H, Dharmapuri S, Moole V, Boddireddy R, Yedama P et al (2017) Success of photodynamic therapy in palliating patients with nonresectable cholangiocarcinoma: A systematic review and meta-analysis. World J Gastroenterol 23(7):1278–1288 CrossRef
30.
Zurück zum Zitat Chen P, Yang T, Shi P, Shen J, Feng Q, Su J (2022) Benefits and safety of photodynamic therapy in patients with hilar cholangiocarcinoma: A meta-analysis. Photodiagnosis Photodyn Ther 37:102712 CrossRef Chen P, Yang T, Shi P, Shen J, Feng Q, Su J (2022) Benefits and safety of photodynamic therapy in patients with hilar cholangiocarcinoma: A meta-analysis. Photodiagnosis Photodyn Ther 37:102712 CrossRef
31.
Zurück zum Zitat Sofi AA, Khan MA, Das A, Sachdev M, Khuder S, Nawras A et al (2018) Radiofrequency ablation combined with biliary stent placement versus stent placement alone for malignant biliary strictures: a systematic review and meta-analysis. Gastrointest Endosc 87(4):944–951.e1 CrossRef Sofi AA, Khan MA, Das A, Sachdev M, Khuder S, Nawras A et al (2018) Radiofrequency ablation combined with biliary stent placement versus stent placement alone for malignant biliary strictures: a systematic review and meta-analysis. Gastrointest Endosc 87(4):944–951.e1 CrossRef
32.
Zurück zum Zitat de Jong DM, Fritzsche JA, Audhoe AS, Yi SSL, Bruno MJ, Voermans RP et al (2022) Comparison of intraductal RFA plus stent versus stent-only treatment for unresectable perihilar cholangiocarcinoma—A systematic review and meta-analysis. Cancers (Basel) 14(9):2079 CrossRef de Jong DM, Fritzsche JA, Audhoe AS, Yi SSL, Bruno MJ, Voermans RP et al (2022) Comparison of intraductal RFA plus stent versus stent-only treatment for unresectable perihilar cholangiocarcinoma—A systematic review and meta-analysis. Cancers (Basel) 14(9):2079 CrossRef
33.
Zurück zum Zitat Song S, Jin H, Cheng Q, Gong S, Lv K, Lei T et al (2022) Local palliative therapies for unresectable malignant biliary obstruction: radiofrequency ablation combined with stent or biliary stent alone? An updated meta-analysis of nineteen trials. Surg Endosc 36(8):5559–5570 CrossRef Song S, Jin H, Cheng Q, Gong S, Lv K, Lei T et al (2022) Local palliative therapies for unresectable malignant biliary obstruction: radiofrequency ablation combined with stent or biliary stent alone? An updated meta-analysis of nineteen trials. Surg Endosc 36(8):5559–5570 CrossRef
34.
Zurück zum Zitat Mohammad T, Kahaleh M (2022) Comparing palliative treatment options for cholangiocarcinoma: photodynamic therapy vs. radiofrequency ablation. Clin Endosc 55(3):347–354 CrossRef Mohammad T, Kahaleh M (2022) Comparing palliative treatment options for cholangiocarcinoma: photodynamic therapy vs. radiofrequency ablation. Clin Endosc 55(3):347–354 CrossRef
35.
Zurück zum Zitat Mohan BP, Chandan S, Khan SR, Kassab LL, Ponnada S, Artifon ELA et al (2022) Photodynamic therapy (PDT), Radiofrequency ablation (RFA) with biliary stents in palliative treatment of unresectable extrahepatic cholangiocarcinoma: A systematic review and meta-analysis. J Clin Gastroenterol 56(2):e153–e160 CrossRef Mohan BP, Chandan S, Khan SR, Kassab LL, Ponnada S, Artifon ELA et al (2022) Photodynamic therapy (PDT), Radiofrequency ablation (RFA) with biliary stents in palliative treatment of unresectable extrahepatic cholangiocarcinoma: A systematic review and meta-analysis. J Clin Gastroenterol 56(2):e153–e160 CrossRef
36.
Zurück zum Zitat Yang J, Wang J, Zhou H, Wang Y, Huang H, Jin H et al (2020) Endoscopic radiofrequency ablation plus a novel oral 5‑fluorouracil compound versus radiofrequency ablation alone for unresectable extrahepatic cholangiocarcinoma. Gastrointest Endosc 92(6):1204–1212.e1 CrossRef Yang J, Wang J, Zhou H, Wang Y, Huang H, Jin H et al (2020) Endoscopic radiofrequency ablation plus a novel oral 5‑fluorouracil compound versus radiofrequency ablation alone for unresectable extrahepatic cholangiocarcinoma. Gastrointest Endosc 92(6):1204–1212.e1 CrossRef
37.
Zurück zum Zitat Inoue T, Naitoh I, Kitano R, Ibusuki M, Kobayashi Y, Sumida Y et al (2022) Endobiliary radiofrequency ablation combined with gemcitabine and cisplatin in patients with unresectable extrahepatic cholangiocarcinoma. Curr Oncol 29(4):2240–2251 CrossRef Inoue T, Naitoh I, Kitano R, Ibusuki M, Kobayashi Y, Sumida Y et al (2022) Endobiliary radiofrequency ablation combined with gemcitabine and cisplatin in patients with unresectable extrahepatic cholangiocarcinoma. Curr Oncol 29(4):2240–2251 CrossRef
Metadaten
Titel
Endoskopisch gesteuerte Diagnostik und Therapie von Cholangiokarzinomen
verfasst von
Prof. Dr. med. Ulrike Denzer
Prof. Dr. med. Alexander Dechêne
Publikationsdatum
04.01.2023
Verlag
Springer Medizin
Erschienen in
Die Gastroenterologie / Ausgabe 1/2023
Print ISSN: 2731-7420
Elektronische ISSN: 2731-7439
DOI
https://doi.org/10.1007/s11377-022-00667-y

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