Inflammation and Carcinogenesis of the Biliary Tract: Update On Endoscopic Treatment  Richard A. Kozarek  Clinical Gastroenterology and Hepatology  Volume 7, Issue 11, Pages S89-S94 (November 2009) DOI: 10.1016/j.cgh.2009.08.026 Copyright © 2009 AGA Institute Terms and Conditions

Figure 1 Bismuth type 3 CCA treated with bilateral 10 French plastic prostheses. Clinical Gastroenterology and Hepatology 2009 7, S89-S94DOI: (10.1016/j.cgh.2009.08.026) Copyright © 2009 AGA Institute Terms and Conditions

Figure 2 (A) Major mass intrahepatic CCA in a patient presenting with weight loss and jaundice. (B) Note palliation with single SEMS, placed into dominant left intrahepatic duct. NITI-S SEMS (TaeWoong Inc, Seoul, Korea). Clinical Gastroenterology and Hepatology 2009 7, S89-S94DOI: (10.1016/j.cgh.2009.08.026) Copyright © 2009 AGA Institute Terms and Conditions

Figure 3 (A) Magnetic resonance cholangiopancreatography showing Type IV bifurcation tumor with multiple isolated intrahepatic ducts. (B) Two SEMSs placed into right intrahepatic system failed to relieve jaundice. Arrow depicts high-grade stenosis of dilated left intrahepatic duct. Following manipulation into left system with a Soehendra screw dilator (C) access is maintained (D) to allow placement of a third SEMS (E). Clinical Gastroenterology and Hepatology 2009 7, S89-S94DOI: (10.1016/j.cgh.2009.08.026) Copyright © 2009 AGA Institute Terms and Conditions

Figure 4 Type 3 CCA (A), treated with “Y” configuration SEMSs (B) followed by PDT (C, D). Clinical Gastroenterology and Hepatology 2009 7, S89-S94DOI: (10.1016/j.cgh.2009.08.026) Copyright © 2009 AGA Institute Terms and Conditions

Figure 5 Kaplan–Meier survival curve of randomized patients treated with PDT plus stenting (group A, n = 20), and of patients with stenting alone (group B, n = 19). Survival was longer in group A compared with group B (P < .0001). +, patients still alive. Reprinted with permission, Ortner MEJ, Caca K, Berr F, et al. Successful photodynamic therapy for nonresectable cholangiocarcinoma: a randomized prospective study. Gastroenterology 2003;125:1358. Clinical Gastroenterology and Hepatology 2009 7, S89-S94DOI: (10.1016/j.cgh.2009.08.026) Copyright © 2009 AGA Institute Terms and Conditions

Figure 6 Extrahepatic CCA causing gastric outlet obstruction and jaundice treated with (A) enteral and (B) biliary SEMSs. Clinical Gastroenterology and Hepatology 2009 7, S89-S94DOI: (10.1016/j.cgh.2009.08.026) Copyright © 2009 AGA Institute Terms and Conditions