Abstract
Malignant hilar biliary strictures invariably involve the Bc region. It is technically demanding to decompress the obstructed bile ducts, and the segmental cholangitis is often complicated after the incomplete drainage. There are several controversies regarding the decompression of the malignant hilar biliary strictures. In unresectable cases, transpapillary drainage is preferable for the patient due to the avoidance of external catheterization. However, it is more difficult to deploy the multiple stents through this route. The metallic stent is superior to the plastic stent with regard to stent patency. However, technical competence may be demanded in case of stent obstruction. In addition, the superiority of bilateral stent deployment to the unilateral one is not decided yet. Each selection implies both superiority and inferiority. Therefore, it is important to judge from several points such as the patient prognosis, adjuvant therapy, operator's proficiency including the technique to manage the stent obstruction, and the cost. Moreover, it is also mandatory to understand the anatomy of biliary branches, to select the suitable device, and to perform the safe stent deployment.
