Gut 51:vi1-vi9 doi:10.1136/gut.51.suppl_6.vi1

Guidelines for the diagnosis and treatment of cholangiocarcinoma: consensus document

  1. S A Khan1,
  2. B R Davidson2,
  3. R Goldin3,
  4. S P Pereira4,
  5. W M C Rosenberg5,
  6. S D Taylor-Robinson1,
  7. A V Thillainayagam6,
  8. H C Thomas1,
  9. M R Thursz1,
  10. H Wasan7
  1. 1Liver Unit, Department of Medicine A, Imperial College School of Medicine, St Mary’s Hospital Campus, South Wharf Street, London W2 1PG, UK
  2. 2Department of Hepatobiliary Surgery, Royal Free Hospital, Pond Street, London NW3 2QG, UK
  3. 3Department of Histopathology, Imperial College School of Medicine, St Mary’s Hospital Campus, South Wharf Street, London W2 1PG, UK
  4. 4Department of Gastroenterology, Middlesex Hospital, University College London Hospitals, Mortimer Street, London W1N 8AA, UK
  5. 5University of Southampton, Southampton General Hospital, Tremona Road, Southampton SO16 6YD, UK
  6. 6Department of Gastroenterology, Imperial College School of Medicine, Charing Cross Hospital Campus, Fulham Palace Rd, London W6 8RF, UK
  7. 7Department of Oncology, Imperial College School of Medicine, Hammersmith Hospital Campus, Du Cane Road, London W12 OHS, UK
  1. Correspondence to:
    C Romaya, Audit Office, British Society of Gastroenterology, 3 St Andrew’s Place, Regents Park, London NW1 4LB, UK;
  • Accepted 15 May 2002


1.1 Development of guidelines

There is currently no clear national consensus for the optimal diagnosis and treatment of cholangiocarcinoma. The need for these guidelines was highlighted following the annual meeting of the British Association for the Study of the Liver (BASL) in September 2000. During their development these guidelines were presented at a BASL Liver Cancer Workshop in January 2001. They were also circulated to BASL members and the Liver Section of the British Society of Gastroenterology (BSG) Committee members, including gastroenterologists, hepatologists, gastroenterological surgeons, pathologists, radiologists, and epidemiologists for comments before the final consensus document was drawn up.

1.2 Strategy

The guidelines are based on comprehensive literature surveys including results from randomised controlled trials, systematic reviews and meta-analyses, and cohort, prospective, and retrospective studies. On issues where no significant study data were available, evidence was obtained from expert committee reports or opinions. Where possible, specific recommendations have been graded, based on the quality of evidence available (section 2.4).

1.3 Context and intent

These guidelines are intended to bring consistency and improvement in the patient’s management from first suspicion of cholangiocarcinoma through to confirmation of the diagnosis and subsequent management. As stated in previous BSG guidelines, patient preferences must be sought and decisions made jointly by the patient and health carer, based on the risks and benefits of any intervention.

Furthermore, the guidelines should not necessarily be regarded as the standard of care for all patients. Individual cases must be managed on the basis of all clinical data available for that case. The guidelines are subject to change in light of future advances in scientific knowledge.


Mortality rates from intrahepatic cholangiocarcinoma have risen steeply and steadily over the past 30 years and since the mid 1990s more deaths have been coded annually in England and Wales as being due to this tumour than to hepatocellular carcinoma.1 In 1997 and …

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