Editing Cholangiocarcinoma (section)

===Imaging of the biliary tree===
[[File:ERCP cholangioca.jpg|thumb|right|[[Endoscopic retrograde cholangiopancreatography|ERCP]] image of cholangiocarcinoma, showing common bile duct stricture and dilation of the proximal common bile duct]]
While abdominal imaging can be useful in the diagnosis of cholangiocarcinoma, direct imaging of the [[bile duct]]s is often necessary. [[Endoscopic retrograde cholangiopancreatography]] (ERCP), an [[endoscopy|endoscopic]] procedure performed by a [[gastroenterologist]] or specially trained surgeon, has been widely used for this purpose. Although ERCP is an invasive procedure with attendant risks, its advantages include the ability to obtain [[biopsy|biopsies]] and to place [[stent]]s or perform other interventions to relieve biliary obstruction.<ref name="feldman2"/> [[Endoscopic ultrasound]] can also be performed at the time of ERCP and may increase the accuracy of the biopsy and yield information on [[lymph node]] invasion and operability.<ref>{{cite journal | vauthors = Sugiyama M, Hagi H, Atomi Y, Saito M | title = Diagnosis of portal venous invasion by pancreatobiliary carcinoma: value of endoscopic ultrasonography | journal = Abdominal Imaging | volume = 22 | issue = 4 | pages = 434–8 | year = 1997 | pmid = 9157867 | doi = 10.1007/s002619900227 | s2cid = 19988847 }}</ref> As an alternative to ERCP, [[percutaneous transhepatic cholangiography]] (PTC) may be utilized. [[Magnetic resonance cholangiopancreatography]] (MRCP) is a [[non-invasive]] alternative to ERCP.<ref>{{cite journal | vauthors = Schwartz LH, Coakley FV, Sun Y, Blumgart LH, Fong Y, Panicek DM | title = Neoplastic pancreaticobiliary duct obstruction: evaluation with breath-hold MR cholangiopancreatography | journal = AJR. American Journal of Roentgenology | volume = 170 | issue = 6 | pages = 1491–5 | date = June 1998 | pmid = 9609160 | doi = 10.2214/ajr.170.6.9609160 | doi-access = free }}</ref><ref>{{cite journal | vauthors = Zidi SH, Prat F, Le Guen O, Rondeau Y, Pelletier G | title = Performance characteristics of magnetic resonance cholangiography in the staging of malignant hilar strictures | journal = Gut | volume = 46 | issue = 1 | pages = 103–6 | date = January 2000 | pmid = 10601064 | pmc = 1727781 | doi = 10.1136/gut.46.1.103 }}</ref><ref>{{cite journal | vauthors = Lee MG, Park KB, Shin YM, Yoon HK, Sung KB, Kim MH, Lee SG, Kang EM | display-authors = 6 | title = Preoperative evaluation of hilar cholangiocarcinoma with contrast-enhanced three-dimensional fast imaging with steady-state precession magnetic resonance angiography: comparison with intraarterial digital subtraction angiography | journal = World Journal of Surgery | volume = 27 | issue = 3 | pages = 278–83 | date = March 2003 | pmid = 12607051 | doi = 10.1007/s00268-002-6701-1 | s2cid = 25092608 }}</ref> Some authors have suggested that MRCP should supplant ERCP in the diagnosis of biliary cancers, as it may more accurately define the tumor and avoids the risks of ERCP.<ref>{{cite journal | vauthors = Yeh TS, Jan YY, Tseng JH, Chiu CT, Chen TC, Hwang TL, Chen MF | display-authors = 6 | title = Malignant perihilar biliary obstruction: magnetic resonance cholangiopancreatographic findings | journal = American Journal of Gastroenterology | volume = 95 | issue = 2 | pages = 432–40 | date = February 2000 | doi = 10.1111/j.1572-0241.2000.01763.x | pmid = 10685746 | s2cid = 25350361 }}</ref><ref>{{cite journal | vauthors = Freeman ML, Sielaff TD | title = A modern approach to malignant hilar biliary obstruction | journal = Reviews in Gastroenterological Disorders | volume = 3 | issue = 4 | pages = 187–201 | year = 2003 | pmid = 14668691 }}</ref><ref>{{cite journal | vauthors = Szklaruk J, Tamm E, Charnsangavej C | title = Preoperative imaging of biliary tract cancers | journal = Surgical Oncology Clinics of North America | volume = 11 | issue = 4 | pages = 865–76 | date = October 2002 | pmid = 12607576 | doi = 10.1016/S1055-3207(02)00032-7 }}</ref>