The role of endoscopic ultrasound in cholangiocarcinoma

The role of endoscopic ultrasound (EUS) in cholangiocarcinoma (CCA) has grown in recent years due to the suboptimal endoscopic methods in obtaining tissue diagnosis. The current chapter focuses on the role of EUS in the diagnosis and staging of CCA. While EUS-guided fine needle aspiration (FNA) of the primary CCA tumor is strongly discouraged due to risk of tumor seeding, EUS-FNA plays an essential role in evaluating CCA-associated lymphadenopathy and has a significant impact on prognosis and guiding management. Regardless of cross-sectional imaging (unless unresectable disease is identified), EUS can be useful in providing enhanced staging data, primarily via improved nodal assessment. Although primary sclerosing cholangitis and the presence of biliary stents can hinder EUS performance, their impact is greatly minimized by adopting careful examination techniques.