Modified Endoscopic Biliary Stent Combined with Photodynamic Therapy: A New Strategy for the Palliative Treatment of Extrahepatic Cholangiocarcinoma.

Background: Photodynamic therapy (PDT) combined with biliary stenting reportedly has better efficacy and safety in the treatment of extrahepatic cholangiocarcinoma (EHC). Considering the shortcomings of traditional PDT methods, we proposed a novel modified approach, defined as initial biliary stent placement followed by PDT, for the treatment of EHC. The study aimed to evaluate the effect and safety of biliary stent placement prior to PDT versus only stent placement on the treatment of EHC. Methods: A total of 30 patients diagnosed with EHC between January 2017 and December 2024 were included in the retrospective study. Ten patients underwent biliary stent placement, followed by PDT (Stenting with PDT group). Survival time, surgical success rate, and postoperative adverse events were compared to 20 patients receiving biliary stent placement alone (Stenting only group). Results: The success rate of all operations in both groups was 100%. After 96 months of follow-up, the stenting with PDT group had significantly longer median survival after stent placement than the stenting only group (10.5 vs. 4.0 months, p = 0.028). There were no statistically significant differences in the rates of postoperative total adverse events (5 [25%] vs. 2 [20%], p = 1.000), asymptomatic hyperamylasemia (1 [5%] vs. 1 [10%], p = 1.000), acute pancreatitis (4 [20%] vs. 1 [10%], p = 0.272), and postoperative acute cholangitis (0 vs. 1 [10%], p = 0.333) between the two groups. Conclusions: Compared with stenting alone, modified stenting combined with PDT resulted in longer survival in patients with unresectable EHC without significant adverse events.