e. volume of liver drainage, life expectancy, expertise of the facility, etc. Recently, radio-frequency ablation and photodynamic therapy are promising techniques that may extend

drainage patency. Through a review in the literature and regional data, the Asia–Pacific Working Group for hepatobiliary cancers has developed statements to assist clinicians in diagnosing and managing of HCCA. After voting anonymously using modified Delphi method, all final statements were determined for the level of evidence quality and strength of recommendation. Hilar cholangiocarcinoma (HCCA) is one of the most common type of bile duct cancers reported in the world, and the Asia–Pacific region reported the highest incidence.[1] To date, there have been a few guidelines for investigations and management Pifithrin-�� molecular weight of HCCA.[2-4] After the latest guideline,[4]

the techniques in the subject of endoscopy and interventional management EPZ-6438 have been evolved, but there has been no update in the consensus or guideline and only a handful number of reviews are available.[5, 6] The Asia–Pacific Working Group on hepatobiliary cancers was established in 2011 under the auspices of the scientific organizing committee for the Asian Pacific Digestive Disease Week 2012. The Working Group felt that HCCA is the unique type of Asian hepatobiliary cancer that needs to be addressed specifically. Therefore, the goal of this Consensus was to establish recommendations and managements of HCCA with specific relevance to Asian data on the course, standard approach, and recent

advances in the management of HCCA. why Because the role of curative surgery requires detailed explanation as described elsewhere[7, 8] and the techniques are so variable depending on expertise of each operator. After a comprehensive discussion, the group has considered to omit the statement on this part. A modified Delphi process was performed to establish the consensus.[9] The process relied on a combination of the principles of evidence-based medicine through an anonymous voting system. The Consensus Panel opinions were convinced by a systemic literature review. The main stream of the issues was determined according to perceived clinical importance particular to the Asia–Pacific region. A planning group panel (RR, PA, ST, TR) generated a list of statements and distributed it electronically in advance to all Consensus members. The statements were divided into the topics of: epidemiology and nature, histology and tumor markers, cholangioscopy and image enhancement, image diagnosis and determining resectability, biliary drainage, and adjunctive therapies of HCCA. These statements were proposed to the Consensus Group panel for discussion, revision, and voting. A password-secured Web site was populated with relevant literature assembled by the literature review team (RR and PA).