title: Preoperative biliary drainage for hilar cholangiocarcinoma.
abstract: Hilar cholangiocarcinomas grow slowly, and metastases occur late in the natural history. Surgical cure and long-term survival have been demonstrated, when resection margins are clear. Preoperative biliary drainage has been proposed as a way to improve liver function before surgery, and to reduce post-surgical complications. Percutaneous transhepatic biliary drainage (PTBD) with multiple drains was previously the preferred method for the preoperative relief of obstructive jaundice. However, the introduction of percutaneous transhepatic portal vein embolization (PTPE) and wider resection has changed preoperative drainage strategies. Drainage is currently performed only for liver lobes that will remain after resection, and for areas of segmental cholangitis. Endoscopic biliary drainage (EBD) is less invasive than PTBD. Among EBD techniques, endoscopic nasobiliary drainage (ENBD) is preferable to endoscopic biliary stenting (EBS), because secondary cholangitis (due to the retrograde flow of duodenal fluid into the biliary tree) does not occur. ENBD needs to be converted to PTBD in patients with segmental cholangitis, those with a prolonged need for drainage, or when the extent of longitudinal tumor extension is not sufficiently well characterized.
authors.affiliation: Center for Gastroenterology, Teine-Keijinkai Hospital, 1-jo 12-chome, Maeda, Sapporo, 006-8555, Japan.
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Maguchi
authors.forename: Kuniyuki
authors.initials: K
authors.lastname: Takahashi
authors.forename: Akio
authors.initials: A
authors.lastname: Katanuma
authors.forename: Manabu
authors.initials: M
authors.lastname: Osanai
authors.forename: Kazuyuki
authors.initials: K
authors.lastname: Nakahara
authors.forename: Shinpei
authors.initials: S
authors.lastname: Matuzaki
authors.forename: Takahiro
authors.initials: T
authors.lastname: Urata
authors.forename: Hirotoshi
authors.initials: H
authors.lastname: Iwano
mesh_terms: D001650:Bile Duct Neoplasms / Q000000981:diagnostic imaging / Q000628:therapy*; D001653:Bile Ducts, Intrahepatic / Q000000981:diagnostic imaging; D002404:Catheterization; D018281:Cholangiocarcinoma / Q000000981:diagnostic imaging / Q000628:therapy*; D002758:Cholangiography; D002761:Cholangitis / Q000209:etiology / Q000517:prevention & control; D004322:Drainage / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D011300:Preoperative Care