A recent study published in Endoscopy International has revealed that endoscopic ultrasound with tissue acquisition (EUS-TA) could be useful for patients with potentially resectable perihilar cholangiocarcinoma (pCCA). This study was conducted to evaluate the usefulness of EUS-TA and how it affects clinical decision-making.

The pCCA resectability depends on factors such as biliary tumor extension and vascular involvement. Patient’s prognosis depends on presence of regional lymph nodes (MLNs) and distant metastases. This study is a retrospective, multi-center cohort study carried out at three tertiary referral centers in the Netherlands specializing in pancreatic and bile duct diseases. All patients who had potentially resectable pCCA and underwent EUS preoperatively between 2010 and 2020 were included.

Read more about cholangiocarcinoma therapies

Continue Reading

The research team performed EUS procedures using a linear ultrasound endoscope, while 19-, 20-, 22- or 25-G needles were used for FNA and FNB. Regional LNs included those near the liver hilum, cystic duct, common bile duct, hepatic artery, and portal vein, while extra-regional LNs were those found near the periaortic region, pericaval region, superior mesenteric artery, and celiac trunk. The study also collected data on patient demographics, cross-sectional imaging, EUS, surgery, and clinical outcomes. Suspicious LNs on cross-sectional images were defined by location, size, and heterogeneity based on the assessment of reporting radiologists.

In 77 of 141 patients (55 %), at least one EUS with LN assessment was performed. Out of 141 patients, 169 EUS procedures were performed. 77 (55%) patients underwent at least one EUS with LN assessment. Out of the 96 (68%) patients who had LNs described, EUS-TA was successfully performed in 67 (70%) patients across 88 (55%) LNs. In LNs suspected of malignancy, EUS-TA was successful in 81 (62%) and not successful in 9 (7%) due to scope position or patient discomfort. Out of the 88 biopsied LNs, 23 (26%) were malignant, 53 (60%) were nonmalignant, 11 (13%) were nondiagnostic, and one (1%) was missing. Furthermore, FNA was performed in 75 (85%) of the biopsied LNs, with 20 (27%) confirmed as malignant, while FNB was completed in 12 (14%), with 3 (25%) confirmed malignancy.

The study found that EUS-TA had a higher clinical impact in terms of changing clinical management than those without EUS-TA (20% vs. 12%, P= .048). Additionally, there was no difference in the identification of MLNs at the surgery in both groups (39% vs. 29%, P= .4).

The cross-sectional imaging method has limited accuracy in determining LN involvement. In patients who showed suspicious LNs in cross-sectional imaging, 37% had confirmed MLNs through EUS-TA or surgery, compared to 18% without suspicious LNs in cross-sectional imaging.

The authors noted several limitations in the study. First, the study’s retrospective design resulted in limited detail in reporting specific LN locations and characteristics. Second, the study focused solely on the role of EUS and included only patients who underwent a EUS, which may have overestimated the accuracy of cross-sectional imaging in detecting LNs.

“Our study supports further prospective evaluation of routine implementation of EUS in patients with potentially resectable pCCA,” the authors noted.


Jong DMD, Vondervoort SVD, Dwarkasing RS, et al. Endoscopic ultrasound in patients with resectable perihilar cholangiocarcinoma: impact on clinical decision-making. Endosc Int Open. Published online February 2, 2023. https://doi.org/10.1055/a-2005-3679