title: Endoscopic treatment of malignant biliary strictures.
abstract: Endoscopic stenting is a widely accepted strategy for providing effective drainage in both extrahepatic and intrahepatic malignant strictures. In patients with extrahepatic malignancies, uncovered self-expanding metal stents (SEMS) provide excellent palliation. Hilar malignancies are probably best palliated by placement of uncovered SEMS although some disagreement exists among experts regarding the type and number of stents for optimal palliation. Preoperative biliary drainage (PBD) is commonly performed although a higher risk of complications and the lack of clear benefit raise questions about this practice. Certain groups of patients such as those with markedly elevated bilirubin levels, and in those in whom neoadjuvant therapy is planned, are good candidates for PBD. Considerable controversy exists regarding the optimal method as well as type of stent for PBD in patients with hilar malignancies. Novel endoscopic therapies, including photodynamic therapy and radiofrequency ablation, have emerged as potential adjuvant therapies in the management of malignant bile duct strictures but need further long-term evaluation to establish survival benefit. This review focuses on the current status of endoscopic therapies for malignant biliary obstructions.
authors.affiliation: Section of Digestive Diseases, Department of Internal Medicine, Yale University School of Medicine, 333 Cedar Street, 1080 LMP, PO Box 208019, New Haven, CT, 06520, USA, tarun.rustagi@yale.edu.
authors.forename: Tarun
authors.initials: T
authors.lastname: Rustagi
authors.forename: Priya A
authors.initials: PA
authors.lastname: Jamidar
mesh_terms: D001650:Bile Duct Neoplasms / Q000150:complications* / Q000601:surgery; D017115:Catheter Ablation; D002779:Cholestasis / Q000209:etiology / Q000628:therapy*; D004322:Drainage / Q000295:instrumentation / Q000379:methods*; D016145:Endoscopy, Digestive System / Q000295:instrumentation / Q000379:methods*; D006801:Humans; D008113:Liver Neoplasms / Q000150:complications* / Q000601:surgery; D010166:Palliative Care / Q000379:methods; D011300:Preoperative Care / Q000379:methods; D015607:Stents; D016896:Treatment Outcome