Endoscopic and percutaneous approaches to the treatment of biliary tract and primary liver tumors: controversies and advances.

Advances in percutaneous and endoscopic techniques have improved preoperative selection and optimization in patients with biliary and liver tumors, but are not without their own controversies. Selective rather than routine preoperative biliary drainage (PBD) should be employed, as PBD may be associated with increased infectious complications. Endoscopic ampullectomy (EA) offers advantages in morbidity and mortality over surgical approaches and should be the first line therapy for benign ampullary lesions. Ampullary cancers require pancreaticoduodenectomy. Effectiveness of percutaneous ablative techniques is dependent on tumor size and can be used as palliative therapy, as a bridge to transplantation, or, in select situations, as definitive therapy.