title: Malignant Biliary Obstruction: Evidence for Best Practice.
abstract: What should be done next? Is the stricture benign? Is it resectable? Should I place a stent? Which one? These are some of the questions one ponders when dealing with biliary strictures. In resectable cases, ongoing questions remain as to whether the biliary tree should be drained prior to surgery. In palliative cases, the relief of obstruction remains the main goal. Options for palliative therapy include surgical bypass, percutaneous drainage, and stenting or endoscopic stenting (transpapillary or via an endoscopic ultrasound approach). This review gathers scientific foundations behind these interventions. For operable cases, preoperative biliary drainage should not be performed unless there is evidence of cholangitis, there is delay in surgical intervention, or intense jaundice is present. For inoperable cases, transpapillary stenting after sphincterotomy is preferable over percutaneous drainage. The use of plastic stents (PS) has no benefit over Self-Expandable Metallic Stents (SEMS). In case transpapillary drainage is not possible, Endoscopic Ultrasonography- (EUS-) guided drainage is still an option over percutaneous means. There is no significant difference between the types of SEMS and its indication should be individualized.
authors.affiliation: Setor de Endoscopia Gastrointestinal, Departamento de Gastroenterologia, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, 05403-000 São Paulo, SP, Brazil.
authors.forename: Leonardo Zorrón Cheng Tao
authors.initials: LZ
authors.lastname: Pu
authors.affiliation: Gastroenterology Department, Lyell McEwen Hospital, Adelaide, Haydown Road, Elizabeth Vale, SA 5112, Australia.
authors.forename: Rajvinder
authors.initials: R
authors.lastname: Singh
authors.affiliation: Gastroenterology Department, Lyell McEwen Hospital, Adelaide, Haydown Road, Elizabeth Vale, SA 5112, Australia.
authors.forename: Cheong Kuan
authors.initials: CK
authors.lastname: Loong
authors.affiliation: Setor de Endoscopia Gastrointestinal, Departamento de Gastroenterologia, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, 05403-000 São Paulo, SP, Brazil.
authors.forename: Eduardo Guimarães Hourneaux
authors.initials: EG
authors.lastname: de Moura