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How to access photodynamic therapy for bile duct carcinoma.
[cholangiocarcinoma]
Photodynamic
therapy
(
PDT
)
is
a
promising
treatment
option
for
local
control
of
remnant
cancer
after
surgical
resection
or
biliary
stenosis
by
the
unresectable
tumor
in
patients
with
bile
duct
carcinomas
(
BDC
)
.
To
achieve
effective
tumor
necrosis
,
an
appropriate
approach
to
laser
irradiation
is
necessary
.
The
efficacy
of
endoscopy-guided
PDT
using
porfimer
(
n
=
12
)
or
talaporfin
sodium
(
n
=
13
)
was
investigated
by
evaluating
the
transhepatic
biliary
routes
and
endoscopic
retrograde
biliary
(
ERB
)
routes
in
25
patients
with
BDC
.
Diseases
included
perihilar
intrahepatic
cholangiocarcinoma
(
ICC
)
in
four
patients
,
extrahepatic
BDCs
in
19
and
ampular
carcinoma
(
AC
)
in
two
patients
.
Adjuvant
PDT
after
surgical
resection
was
performed
in
18
patients
,
and
PDT
for
tumor
biliary
stenosis
was
performed
in
seven
.
In
patients
undergoing
surgical
resections
,
the
mean
period
between
the
operation
and
PDT
was
87
±
42
days
.
In
patients
who
underwent
prior
surgical
resections
,
the
transhepatic
route
was
used
in
five
(
28
%
)
,
the
jejunal
loop
was
used
in
11
(
61
%
)
,
the
T
-
tube
route
was
used
in
one
,
and
the
endoscopic
retrograde
cholangiography
(
ERC
)
route
via
papilla
Vater
was
used
in
one
.
In
unresectable
BDC
,
the
ERC
route
was
used
in
four
patients
(
57
%
)
,
and
the
transhepatic
biliary
route
was
used
in
three
(
43
%
)
.
Endoscopic-guided
PDT
could
not
be
performed
in
one
patient
because
of
a
technical
failure
.
Except
for
the
complication
of
photosensitivity
,
endoscopy-related
complications
were
not
observed
in
any
patients
.
Patients
undergoing
PDT
with
porfimer
sodium
had
a
significantly
longer
admission
period
compared
to
patients
undergoing
PDT
with
talaporfin
sodium
(
36
vs
.
5
days
,
respectively
)
(
P
<
0
.
01
)
.
PDT
was
safely
and
definitively
performed
using
the
endoscopy-guided
approach
via
the
transhepatic
or
ERC
route
.
By
considering
the
disadvantages
of
both
routes
,
PDT
must
be
adequately
achieved
for
local
control
of
BDC
.
Diseases
Validation
Diseases presenting
"endoscopic retrograde biliary"
symptom
cholangiocarcinoma
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