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Related Experiment Video

Updated: May 12, 2026

Endoscopic Ultrasound-Guided Biliary Drainage: Endoscopic Ultrasound-Guided Hepaticogastrostomy in Malignant Biliary Obstruction

Endoscopic Ultrasound-Guided Biliary Drainage: Endoscopic Ultrasound-Guided Hepaticogastrostomy in Malignant Biliary Obstruction

Published on: March 25, 2022

Current status and issues regarding biliary stenting in unresectable biliary obstruction.

Takao Itoi¹, Atsushi Sofuni, Fumihide Itokawa

¹Department of Gastroenterology and Hepatology, Tokyo Medical University Hospital, Tokyo, Japan. itoi@tokyo-med.ac.jp

Digestive Endoscopy : Official Journal of the Japan Gastroenterological Endoscopy Society

|April 27, 2013

Summary

Self-expandable metallic stents (SEMS) are ideal for unresectable malignant biliary strictures. However, optimal SEMS selection and placement for distal strictures require further research and randomized controlled trials.

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Endoscopic Ultrasound-Guided Biliary Drainage: Endoscopic Ultrasound-Guided Hepaticogastrostomy in Malignant Biliary Obstruction

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Published on: January 9, 2026

Area of Science:

Gastroenterology
Oncology
Interventional Radiology

Background:

Malignant biliary strictures pose significant challenges in unresectable cases.
Biliary stenting is a primary palliative treatment.
Optimizing stent selection and technique is crucial for patient outcomes.

Purpose of the Study:

To review the current status of biliary stenting for unresectable malignant biliary strictures.
To evaluate the role of self-expandable metallic stents (SEMS).
To identify areas of ongoing debate and future research needs.

Main Methods:

Review of current literature on biliary stenting techniques.
Analysis of the application of SEMS in distal and hilar biliary strictures.
Discussion of various stent-related parameters and procedural choices.

Main Results:

SEMS are considered the ideal stent for both distal and hilar biliary strictures.
Specific choices for distal strictures, including stent type (covered vs. uncovered), placement (suprapapillary vs. transpapillary), configuration (side-by-side vs. stent-in-stent), laterality (unilateral vs. bilateral), and need for sphincterotomy, remain debated.
Evidence synthesis highlights the need for further high-quality randomized controlled trials.

Conclusions:

Self-expandable metallic stents are the preferred choice for managing unresectable malignant biliary strictures.
Further high-quality randomized controlled trials are essential to resolve controversies regarding optimal SEMS selection and placement techniques for distal biliary strictures.
Standardization of best practices in biliary stenting will improve patient management.