Carcinomas of the biliary tree are rare tumors of the gastrointestinal tract with rising incidence during the last years. Biliary neoplasms are classified into intra- and extrahepatic cholangiocarcinomas (Klatskin tumor, middle and distal extrahepatic tumors), gallbladder cancer, and ampullary carcinoma. Endoscopic therapy plays a central role in the palliative treatment of bile duct carcinoma. In obstructive jaundice, biliary drainage has few complications and relieves symptoms reliably. It can prevent further complications and is indispensable to the treatment of cholangitis. The principal drawbacks of biliary stents are stent occlusion and cholangitis. Prophylactic antibiotics were not proven to be effective. Technical details concerning material, number and location of stents await further clarification. If existing biliary drainage is insufficient, photodynamic therapy is an already established adjunct to palliative therapy for progressed hilar cholangiocarcinomas since it prolongs survival and improves quality of life. Palliative radio-, chemo-, and radiochemotherapy should be reserved to studies for lack of sufficient data. New therapeutical approaches include brachytherapy as well as the use of modern chemotherapeuticals,COX-2 and receptor tyrosine kinase inhibitors.

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2004
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