title: Staging cholangiocarcinoma by cholangioscopy.
abstract: Peroral cholangioscopy (POCS) and percutaneous transhepatic cholangioscopy (PTCS) were first developed in the 1970s, and technical developments and clinical applications have taken place gradually ever since. POCS is used to diagnose small mucosal biliary lesions in non-icteric patients and early malignant changes in patients with persistent primary sclerosing cholangitis (PSC). Although PTCS is a more invasive diagnostic procedure than POCS, it has the advantage of precise diagnosis with mapping biopsy in defining the proximal and distal extension of superficially spreading cholangiocarcinoma (CCA) or mucin-producing CCA, which is predominantly found in papillary type CCA. POCS is significantly superior to ERCP in distinguishing between malignant and benign dominant bile duct stenoses in patients with PSC. The positive rate of PTCS biopsy for CCA is 96%, while morbidity and mortality of PTCS are 9% and 0%, respectively. Although magnetic resonance (MR) cholangiography may replace PTCS in determining the longitudinal spread of infiltrating type hilar CCA, the accuracy of MR cholangiography in papillary type hilar CCA is significantly lower than that of PTCS.
authors.affiliation: Aichi Cancer Center, Nagoya, Japan. ynimura@aichi-cc.jp
authors.forename: Y
authors.initials: Y
authors.lastname: Nimura
references.citation: Gastrointest Endosc. 2005 Sep;62(3):374-82
references.pmid: 16111955
references.citation: Surg Endosc. 1988;2(4):213-9
references.pmid: 3242144
references.citation: Gastrointest Endosc. 2002 Nov;56(5):688-95
references.pmid: 12397277
references.citation: J Hepatobiliary Pancreat Surg. 1998;5(2):221-5
references.pmid: 9745093
references.citation: Am J Gastroenterol. 1976 Sep;66(3):241-7
references.pmid: 998588
references.citation: J Hepatobiliary Pancreat Surg. 1999;6(2):101-7
references.pmid: 10398895
references.citation: Endoscopy. 1989 Dec;21 Suppl 1:351-6
references.pmid: 2606085
references.citation: Ann Surg. 1998 Mar;227(3):405-11
references.pmid: 9527064
references.citation: World J Surg. 1990 Jul-Aug;14(4):535-43; discussion 544
references.pmid: 2166381
references.citation: Gastrointest Endosc. 2002 Jul;56(1):25-32
references.pmid: 12085031
references.citation: Gastrointest Endosc. 2000 Nov;52(5):630-4
references.pmid: 11060187
references.citation: Am Surg. 1997 Nov;63(11):943-7
references.pmid: 9358776
references.citation: Endoscopy. 2006 Jul;38(7):665-9
references.pmid: 16673310
references.citation: Gastrointest Endosc. 2007 Oct;66(4):730-6
references.pmid: 17905015
references.citation: Endoscopy. 1993 Jan;25(1):76-80
references.pmid: 8384103
references.citation: World J Surg. 1999 Oct;23(10):1038-43; discussion 1043-4
references.pmid: 10512944
references.citation: World J Surg. 1978 May;2(3):379-85
references.pmid: 706428
references.citation: Gastrointest Endosc. 2000 Sep;52(3):380-6
references.pmid: 10968854
references.citation: World J Gastroenterol. 2005 Nov 7;11(41):6554-6
references.pmid: 16425434