[The evaluation of endoscopic biliary drainage for 288 patients with malignant hilar obstruction]

Hilar tumors are extremely difficult to manage with a considerably lower resection rate. We performed endoscopic biliary drainage for 288 patients with hilar tumors (Klatskin tumor 184, gallbladder carcinoma 23, HCC 47 and other metastases 34) in the past 3 years. 162 patients underwent endoscopic nasobiliary drainage, 80 plastic biliary stenting, and 46 expandable metal stent implantation. 4 patients were given double stents insertion simultaneously, 43.1% of patients received good drainage with the total effective rate of 67.0%, but postprocedure cholangitis took place in 13.8% of patients within one month and 3 died of cholangitis and sepsis. In the long-term follow-up patients without surgical treatment, the median sruvival was 5.3 months. The outcome was closely related to Bismuth types, and jaundice could be relieved if more than about 40% of the liver was drained. The double stents for the left and right intrahepatic duct in the meantime could enlarge drainage area and improve the theraputic effectiveness. To get highest benefit, the 3 endoscopic biliary drainage methods should be choosen properly and exchanged flexibly. We conclude that endoscopic biliary drainage is a safe and useful management for the hilar tumor and should be the treatment of choice for palliating jaundice in the inoperable patients.