title: Preoperative biliary drainage for hilar cholangiocarcinoma: which stent should be selected?
abstract: The controversy over whether and how to perform preoperative biliary drainage (PBD) in patients with hilar cholangiocarcinoma (HCA) remains unsettled. Arguments against PBD before pancreatoduodenectomy have recently been gaining momentum. However, the complication-related mortality rate is as high as 10% for patients with HCA who have undergone major liver resection, and liver failure is a major cause of postoperative death. This suggests the need for PBD to treat jaundice in HCA patients scheduled for major surgical resection of the liver and that major surgery should be performed only after the recovery of hepatic function. No definite criteria or guidelines outlining indications for PBD are currently available. In patients with HCA, PBD may be performed by either percutaneous transhepatic biliary drainage (PTBD) or endoscopic biliary drainage (EBD). No consensus, however, has been reached regarding which drainage method is more appropriate. No reported study has compared the effectiveness of PTBD, endoscopic biliary stenting (EBS), and endoscopic nasobiliary drainage (ENBD) in patients with HCA. This review summarizes the results of our study comparing the three methods and outlines the preoperative endoscopic management of segmental cholangitis (SC) in HCA patients undergoing PBD.
authors.affiliation: Department of Gastroenterology, Hokkaido University Graduate School of Medicine, Kita 15, Nishi 7, Kita-ku, Sapporo 060-8638, Japan. hiropon@med.hokudai.ac.jp
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Kawakami
authors.forename: Satoshi
authors.initials: S
authors.lastname: Kondo
authors.forename: Masaki
authors.initials: M
authors.lastname: Kuwatani
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Yamato
authors.forename: Nobuyuki
authors.initials: N
authors.lastname: Ehira
authors.forename: Taiki
authors.initials: T
authors.lastname: Kudo
authors.forename: Kazunori
authors.initials: K
authors.lastname: Eto
authors.forename: Shin
authors.initials: S
authors.lastname: Haba
authors.forename: Joe
authors.initials: J
authors.lastname: Matsumoto
authors.forename: Kentaro
authors.initials: K
authors.lastname: Kato
authors.forename: Takahiro
authors.initials: T
authors.lastname: Tsuchikawa
authors.forename: Eiichi
authors.initials: E
authors.lastname: Tanaka
authors.forename: Satoshi
authors.initials: S
authors.lastname: Hirano
authors.forename: Masahiro
authors.initials: M
authors.lastname: Asaka
mesh_terms: D001650:Bile Duct Neoplasms / Q000628:therapy*; D001653:Bile Ducts, Intrahepatic; D018281:Cholangiocarcinoma / Q000628:therapy*; D004322:Drainage / Q000295:instrumentation*; D016145:Endoscopy, Digestive System / Q000379:methods; D006801:Humans; D011300:Preoperative Care / Q000379:methods*; D011474:Prosthesis Design; D015607:Stents