Endoscopic diagnosis and treatment for proximal biliary obstruction of tumor origin (literature review)

Proximal biliary obstruction occurs in Klatskin tumor, intrahepatic cholangiocarcinoma, gallbladder cancer or metastatic lesion of the portal fissure and implies poor prognosis. Endoscopic techniques have been advanced towards more accurate diagnosis and safer drainage. Transpapillary brush and forceps biopsy are widely used for morphologic diagnosis. Development of diagnostic techniques includes peroral cholangioscopy and confocal laser endomicroscopy. Due to the development of various tools and advances in ERCP and EUS technologies, a number of technically and clinically successful procedures for high biliary obstruction is increasing. Nevertheless, stent parameters, potential of locoregional palliative care and some other aspects remain disputable. The literature review presents best practices of endoscopic diagnosis and treatment for proximal malignant biliary obstruction, obtained from the analysis of recent scientific publications.