Role of Endoscopy in the Evaluation and Treatment of Patients with Biliary Neoplasia

Publication Date: February 2, 2013

Recommendations

We recommend that EUS be performed in patients with suspected ampullary adenocarcinoma or cholangiocarcinoma if the EUS findings or positive FNA results would change management. (M)
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We recommend MRC to assess for resectability if a CT scan suggests cholangiocarcinoma, particularly of the bifurcation. If the lesion is unresectable, endoscopic palliation of jaundice should be performed by using MRC as a guide for unilateral drainage to minimize the risk of cholangitis. (H)
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We recommend ERCP to obtain tissue or facilitate further evaluation of indeterminate strictures. (M)
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We recommend that symptomatic patients with GBP undergo cholecystectomy. (M)
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We suggest that asymptomatic patients with a GBP larger than 10 mm undergo cholecystectomy. (L)
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We suggest that asymptomatic patients with a GBP 6 mm to 10 mm in size and without other risk factors for GB cancer be followed by TUS every 12 months. (L)
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We recommend that the presence of any GBP should prompt cholecystectomy in patients with PSC. (M)
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CT, computed tomography; ERCP, endoscopic retrograde cholangiopancreatography; EUS, esophageal ultrasound; GBP, gall bladder polyp; MRC, magnetic resonance cholangiography; PSC, primary sclerosing cholangitis; TUS, transabdominal ultrasound

Recommendation Grading

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Overview

Title

Role of Endoscopy in the Evaluation and Treatment of Patients with Biliary Neoplasia

Authoring Organization

Publication Month/Year

February 2, 2013

Supplemental Implementation Tools

Document Type

Guideline

External Publication Status

Published

Country of Publication

US

Inclusion Criteria

Female, Male, Adolescent, Adult, Child, Older adult

Health Care Settings

Ambulatory, Hospital, Outpatient

Intended Users

Radiology technologist, nurse, nurse practitioner, physician, physician assistant

Scope

Assessment and screening, Diagnosis, Management

Diseases/Conditions (MeSH)

D004724 - Endoscopy, D016099 - Endoscopy, Gastrointestinal, D018281 - Cholangiocarcinoma, D001661 - Biliary Tract Neoplasms

Keywords

endoscopy, Biliary tract neoplasia, biliary malignancy

Source Citation

Anderson, M. A., Appalaneni, V., Ben-Menachem, T., Decker, G. A., Early, D. S., Evans, J. A., … Cash, B. D. (2013). The role of endoscopy in the evaluation and treatment of patients with biliary neoplasia. Gastrointestinal Endoscopy, 77(2), 167–174. doi:10.1016/j.gie.2012.09.029