The role of endoscopic retrograde cholangiopancreatography in diagnosis and treatment of cholangiocarcinoma

Introduction: Cholangiocarcinoma, a rare cancer arising from the biliary epithelium, is a significant clinical problem due to its insidious progress and diagnostic difficulties. Endoscopic retrograde cholangiopancreatography (ERCP) allows the localization of obstructions within the bile ducts and permits brush cytology for cytological assessment. It also enables insertion of biliary stents for palliative jaundice treatment. Aim: The aim of this study was to evaluate the clinical efficacy of ERCP in patients with biliary tract carcinoma. Material and methods: We made a retrospective analysis of 929 ERCP performed in the Department of Digestive Tract Diseases, Medical University of Lodz from January 2003 to April 2007. We analysed age, sex, clinical symptoms, laboratory findings, imaging methods and cytological results and disease progress of 55 patients, in whom on the basis of sERCP cholangiocarcinoma was suspected. Final diagnosis of cholangiocarcinoma was based on imaging methods: ultrasonography, computer tomography, ERCP, cytological results and exploratory laparotomy. Results: Finally cholangiocarcinoma was diagnosed in 23 patients from among 55 patients suspected after ERCP In 36 patients during ERCP brush cytology was performed and in 8 (22.2%) patients atypical cells were detected. In 50 (91%) patients biliary stenting and/or percutaneous drainage was performed. No complications after endoscopic stenting were noticed in the majority of patients (91.5%). In two patients (4.2%) perforation of the bile duct, in one patient (2.1%) cholangitis, and in one patient (2.1%) haemorrhage to the digestive tract (2.1%) occurred. Conclusions: Endoscopic retrograde cholangiopancreatography is a safe and effective method in diagnostics and palliative treatment of cholangiocarcinoma.