Endoscopic retrograde cholangiopancreatography (ERCP) and echoendoscopy for cholangiocarcinoma

Cholangiocarcinoma is a biliary system malignancy originating from the liver (intrahepatic), at the confluence of the right and left hepatic ducts (hilar) or in the extrahepatic bile ducts (distal). The incidence of cholangiocarcinoma is increasing but the tumour is usually diagnosed at an advanced stage, resulting in an overall poor prognosis. The difficulty in diagnosis and relatively poor staging accuracy complicate management, so imaging modalities are crucial in the evaluation of this tumour. Nevertheless, endoscopic techniques, including endoscopic retrograde cholangiopancreatography and endoscopic ultrasound, help to establish the diagnosis. Inherent limitations of current approaches to cholangiocarcinoma diagnosis and staging have driven the pursuit of new technologies including intraductal ultrasound, peroral cholangioscopy and other sophisticated modalities discussed in this chapter.