This protocol applies to patients with distal cholangiocarcinoma (not perihilar) whose disease is not amenable to surgery. The immediate clinical problem is distal malignant tract obstruction causing obstructive jaundice, requiring active management to relieve biliary blockage and establish a tissue diagnosis.
The approach centres on an endoscopic procedure — performed as a combined or standalone intervention — to simultaneously secure a pathological diagnosis and achieve biliary decompression. A specific type of biliary stent is used for durable, long-term palliation of jaundice; certain stent types are explicitly avoided in this setting.
Reduction in the degree of jaundice and relief of symptoms associated with biliary obstruction.
Patients with DMTO with inoperable disease from distal CCA should undergo an EUS/ERCP or standalone ERCP to confirm a pathological diagnosis and have their jaundice palliated.
Patients with DMTO from distal CCA should have a fully covered self-expanding metal stent placed.
Plastic stents should not be placed for long-term palliation of jaundice.
In the case of inoperable dCCA causing obstructive jaundice, proceeding to a combined EUS and ERCP or ERCP alone, to make a simultaneous pathological diagnosis along with establishing biliary drainage is recommended.
The goals of drainage are to improve symptoms associated with biliary obstruction and the patient's quality of life, in addition to facilitating the start of palliative chemotherapy by reducing the degree of jaundice.
View source ↗