Endoscopic drainage in patients with inoperable hilar cholangiocarcinoma

Abstract

Hilar cholangiocarcinoma has an extremely poor prognosis and is usually diagnosed at an advanced stage. Palliative management plays an important role in the treatment of patients with inoperable hilar cholangiocarcinoma. Surgical, percutaneous, and endoscopic biliary drainage are three modalities available to resolve obstructive jaundice. Plastic stents were widely used in the past; however, self-expanding metal stents (SEMS) have become popular recently due to their long patency and reduced risk of side branch obstruction, and SEMS are now the accepted treatment of choice for hilar cholangiocarcinoma. Bilateral drainage provides more normal and physiological biliary flow through the biliary ductal system than that of unilateral drainage. Unilateral drainage was preferred until recently because of its technical simplicity. But, with advancements in technology, bilateral drainage now achieves a high success rate and is the preferred treatment modality in many centers. However, the choice of unilateral or bilateral drainage is still controversial, and more studies are needed. This review focuses on the endoscopic method and discusses stent materials and types of procedures for patients with a hilar cholangiocarcinoma.

Role of Minimally Invasive Surgery in Cholangiocarcinoma

“…It was finally concluded that "Endoscopic-ultrasound-guided hepaticogastrostomy is safe and can be a good palliative option for advanced malignant biliary obstruction because it drains internally and is remote from the tumor site, promoting a long patency period of prosthesis and better quality of life (7)." This observation is concordant with the report from other centers (8,9).…”

Stent placement in perihilar cholangiocarcinoma

“…Unfortunately, PSs have a shorter period of patency than SEMSs, and clogging can progress to jaundice and/or cholangitis . PS clogging is thought to be multifactorial and associated with bacterial contamination of undrained bile ducts . PSs may be a viable option for patients with a short life expectancy (usually defined as less than 3 months).…”

“…10 PS clogging is thought to be multifactorial and associated with bacterial contamination of undrained bile ducts. 9,11,12 PSs may be a viable option for patients with a short life expectancy (usually defined as less than 3 months). The prophylactic administration of antibiotics, the administration of ursodeoxycholic acid, and the utilization of wider PSs have been evaluated as ways of reducing PS clogging, but the benefits have been limited.…”

“…The prophylactic administration of antibiotics, the administration of ursodeoxycholic acid, and the utilization of wider PSs have been evaluated as ways of reducing PS clogging, but the benefits have been limited. 9,13,14 SEMSs were developed to overcome the limitations of PSs. 9,15 In patients with hilar obstructions, uncovered SEMSs are generally used to prevent obstruction of the contralateral biliary system.…”

“…9,13,14 SEMSs were developed to overcome the limitations of PSs. 9,15 In patients with hilar obstructions, uncovered SEMSs are generally used to prevent obstruction of the contralateral biliary system. 9 SEMSs have been found to have higher insertion and patency rates than PSs.…”