Role of radiology in the treatment of malignant hilar biliary strictures 1: Review of the literature

Abstract

Malignant strictures of the biliary tree are an uncommon cause of obstructive jaundice. There are a number of pathological subtypes, but tumours in this region tend to have similar clinical and diagnostic features and therapeutic and prognostic implications. We review the published literature on this topic discussing diagnostic modalities and treatment options with a focus on radiological intervention. Diagnosis currently is best achieved using a range of procedures. Direct cholangiography remains the gold standard in delineating anatomy, but the invasiveness of this procedure limits its use as a purely diagnostic tool. Magnetic resonance technology, in particular magnetic resonance cholangiopancreatography, has an increasing role as accessibility is improved. Treatment of these tumours is difficult. Surgical resection and palliative biliary enteric bypass are the most common methods used with endoscopic and percutaneous therapies reserved for palliating patients not fit for surgery. There is little firm evidence to suggest that any one palliative modality is superior. Interventional radiology is particularly suitable for palliative management of difficult and expansive lesions as the anatomy can preclude easy access by surgical or endoscopic techniques. Good palliative results with minimal mortality and morbidity can be achieved with percutaneous stenting.

Palliation of Malignant Obstructive Jaundice

“…When an endoscopic route is used for stent placement, injection of contrast agent into an hepatic segment without adequate subsequent drainage results in bacterial contamination of stagnant bile and resultant cholangitis [8]. It is unclear if this situation also holds true for percutaneous placement of stents [10]. For uncomplicated hilar strictures, one stent is probably sufficient, unless two stents can be inserted with ease.…”

Contribuição da drenagem ecoguiada à paliação endoscópica da obstrução biliar maligna

“…A obstrução pode ocorrer em qualquer nível da árvore biliar, tendo como sítios mais comuns a região proximal (secundário a colangiocarcinomas, hepatocarcinomas ou lesões metastáticas) e distal (secundário às neoplasias periampulares, como tumores de pâncreas e de papila). O correto estadiamento das lesões obstrutivas pela classificação de Bismuth-Corllet pode não apenas determinar o potencial de ressecabilidade das lesões, como também auxiliar adequadamente a escolha sobre a técnica de drenagem a ser realizada (Hii et al, 2004;Chang et al, 1998).…”