Endoscopic biliary stenting in patients with ueresectable biliary cancer

Abstract

Although various kinds of drainage methods to unresectable malignant biliary obstruction has been reported, consensus regarding stenting strategy has not been established. Currently, the symptomatic patients, such as jaundice fever, usually undergo endoscopic transpapillary biliary drainage. In case of distal obstruction, metallic stents are often used, however, there are various options in case of hilar obstruction. Recently, prognosis of the patient with malignant hilar biliary obstruction has been prolonged with the advance in anti-tumor therapy, and we should choose the stenting method considering the feasibility of re-intervention in addition to the initial stent patency on the choice of stenting method. In recent years, EUS-guided biliary drainage (EUS-BD), in which a stent is deploy by puncturing the bile ducts using a linear echoendoscope, has attracted much attention as an alternative drainage route. The endoscopists should perform appropriate procedure according to each biliary stenting after the confirmation of the shape of biliary stricture with imaging study.