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Endoscopic Treatment of Malignant Biliary Strictures

  • Pancreas and Biliary Tract (O Haluszka, Section Editor)
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Abstract

Endoscopic stenting is a widely accepted strategy for providing effective drainage in both extrahepatic and intrahepatic malignant strictures. In patients with extrahepatic malignancies, uncovered self-expanding metal stents (SEMS) provide excellent palliation. Hilar malignancies are probably best palliated by placement of uncovered SEMS although some disagreement exists among experts regarding the type and number of stents for optimal palliation. Preoperative biliary drainage (PBD) is commonly performed although a higher risk of complications and the lack of clear benefit raise questions about this practice. Certain groups of patients such as those with markedly elevated bilirubin levels, and in those in whom neoadjuvant therapy is planned, are good candidates for PBD. Considerable controversy exists regarding the optimal method as well as type of stent for PBD in patients with hilar malignancies. Novel endoscopic therapies, including photodynamic therapy and radiofrequency ablation, have emerged as potential adjuvant therapies in the management of malignant bile duct strictures but need further long-term evaluation to establish survival benefit. This review focuses on the current status of endoscopic therapies for malignant biliary obstructions.

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Tarun Rustagi and Priya A. Jamidar declare no conflict of interest.

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  1. Section of Digestive Diseases, Department of Internal Medicine, Yale University School of Medicine, 333 Cedar Street, 1080 LMP, PO Box 208019, New Haven, CT, 06520, USA

    Tarun Rustagi & Priya A. Jamidar

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  1. Tarun Rustagi
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Correspondence to Priya A. Jamidar.

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This article is part of the Topical Collection on Pancreas and Biliary Tract

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Rustagi, T., Jamidar, P.A. Endoscopic Treatment of Malignant Biliary Strictures. Curr Gastroenterol Rep 17, 3 (2015). https://doi.org/10.1007/s11894-014-0426-9

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