title: How to access photodynamic therapy for bile duct carcinoma.
abstract: BACKGROUND
  Photodynamic therapy (PDT) is a promising treatment option for local control of remnant cancer after surgical resection or biliary stenosis by the unresectable tumor in patients with bile duct carcinomas (BDC). To achieve effective tumor necrosis, an appropriate approach to laser irradiation is necessary.
  
  
  METHODS
  The efficacy of endoscopy-guided PDT using porfimer (n=12) or talaporfin sodium (n=13) was investigated by evaluating the transhepatic biliary routes and endoscopic retrograde biliary (ERB) routes in 25 patients with BDC.
  
  
  RESULTS
  Diseases included perihilar intrahepatic cholangiocarcinoma (ICC) in four patients, extrahepatic BDCs in 19 and ampular carcinoma (AC) in two patients. Adjuvant PDT after surgical resection was performed in 18 patients, and PDT for tumor biliary stenosis was performed in seven. In patients undergoing surgical resections, the mean period between the operation and PDT was 87±42 days. In patients who underwent prior surgical resections, the transhepatic route was used in five (28%), the jejunal loop was used in 11 (61%), the T-tube route was used in one, and the endoscopic retrograde cholangiography (ERC) route via papilla Vater was used in one. In unresectable BDC, the ERC route was used in four patients (57%), and the transhepatic biliary route was used in three (43%). Endoscopic-guided PDT could not be performed in one patient because of a technical failure. Except for the complication of photosensitivity, endoscopy-related complications were not observed in any patients. Patients undergoing PDT with porfimer sodium had a significantly longer admission period compared to patients undergoing PDT with talaporfin sodium (36 vs. 5 days, respectively) (P<0.01).
  
  
  CONCLUSIONS
  PDT was safely and definitively performed using the endoscopy-guided approach via the transhepatic or ERC route. By considering the disadvantages of both routes, PDT must be adequately achieved for local control of BDC.
authors.affiliation: 1 Department of Surgical Oncology, 2 Department of Gastroenterology and Hepatology, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1, Sakamoto, Nagasaki, 852-8501, Japan.
authors.forename: Atsushi
authors.initials: A
authors.lastname: Nanashima
authors.affiliation: 1 Department of Surgical Oncology, 2 Department of Gastroenterology and Hepatology, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1, Sakamoto, Nagasaki, 852-8501, Japan.
authors.forename: Hajime
authors.initials: H
authors.lastname: Isomoto
authors.affiliation: 1 Department of Surgical Oncology, 2 Department of Gastroenterology and Hepatology, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1, Sakamoto, Nagasaki, 852-8501, Japan.
authors.forename: Takafumi
authors.initials: T
authors.lastname: Abo
authors.affiliation: 1 Department of Surgical Oncology, 2 Department of Gastroenterology and Hepatology, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1, Sakamoto, Nagasaki, 852-8501, Japan.
authors.forename: Takashi
authors.initials: T
authors.lastname: Nonaka
authors.affiliation: 1 Department of Surgical Oncology, 2 Department of Gastroenterology and Hepatology, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1, Sakamoto, Nagasaki, 852-8501, Japan.
authors.forename: Tomohito
authors.initials: T
authors.lastname: Morisaki
authors.affiliation: 1 Department of Surgical Oncology, 2 Department of Gastroenterology and Hepatology, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1, Sakamoto, Nagasaki, 852-8501, Japan.
authors.forename: Junichi
authors.initials: J
authors.lastname: Arai
authors.affiliation: 1 Department of Surgical Oncology, 2 Department of Gastroenterology and Hepatology, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1, Sakamoto, Nagasaki, 852-8501, Japan.
authors.forename: Katsunori
authors.initials: K
authors.lastname: Takagi
authors.affiliation: 1 Department of Surgical Oncology, 2 Department of Gastroenterology and Hepatology, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1, Sakamoto, Nagasaki, 852-8501, Japan.
authors.forename: Ken
authors.initials: K
authors.lastname: Ohnita
authors.affiliation: 1 Department of Surgical Oncology, 2 Department of Gastroenterology and Hepatology, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1, Sakamoto, Nagasaki, 852-8501, Japan.
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Shoji
authors.affiliation: 1 Department of Surgical Oncology, 2 Department of Gastroenterology and Hepatology, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1, Sakamoto, Nagasaki, 852-8501, Japan.
authors.forename: Shigetoshi
authors.initials: S
authors.lastname: Urabe
authors.affiliation: 1 Department of Surgical Oncology, 2 Department of Gastroenterology and Hepatology, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1, Sakamoto, Nagasaki, 852-8501, Japan.
authors.forename: Takemasa
authors.initials: T
authors.lastname: Senoo
authors.affiliation: 1 Department of Surgical Oncology, 2 Department of Gastroenterology and Hepatology, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1, Sakamoto, Nagasaki, 852-8501, Japan.
authors.forename: Goshi
authors.initials: G
authors.lastname: Murakami
authors.affiliation: 1 Department of Surgical Oncology, 2 Department of Gastroenterology and Hepatology, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1, Sakamoto, Nagasaki, 852-8501, Japan.
authors.forename: Takeshi
authors.initials: T
authors.lastname: Nagayasu
keywords: Photodynamic therapy (PDT); access route; bile duct carcinoma (BDC); endoscopy; transhepatic; transjejunal; transpapillary