Current Endoscopic Management of Malignant Biliary Stricture

Medicina
Chi-Chih WangMing-Chang Tsai

Abstract

Biliary and pancreatic cancers occur silently in the initial stage and become unresectable within a short time. When these diseases become symptomatic, biliary obstruction, either with or without infection, occurs frequently due to the anatomy associated with these cancers. The endoscopic management of these patients has changed, both with time and with improvements in medical devices. In this review, we present updated and integrated concepts for the endoscopic management of malignant biliary stricture. Endoscopic biliary drainage had been indicated in malignant biliary obstruction, but the concept of endoscopic management has changed with time. Although routine endoscopic stenting should not be performed in resectable malignant distal biliary obstruction (MDBO) patients, endoscopic biliary drainage is the treatment of choice for palliation in unresectable MDBO patients. Self-expanding metal stents (SEMS) have better stent patency and lower costs compared with plastic stents (PS). For malignant hilum obstruction, PS and uncovered SEMS yield similar short-term outcomes, while a covered stent is not usually used due to a potential unintentional obstruction of contralateral ducts.

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Citations

Jun 15, 2021·World Journal of Gastrointestinal Surgery·Maria Vitória Cury Vieira ScatimburgoEduardo Guimarães Hourneaux de Moura

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Methods Mentioned

BETA
biopsy
surgical resection
surgical bypass

Software Mentioned

FCSEMS

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