Endoprosthesis and local irradiation in the treatment of biliary malignancies

Endoscopic biliary drainage by means of a bilio-nasal tube or stent (bilioduodenal endoprosthesis) provides an intermediate or long-term "bridge" for the interrupted bile flow. Insertion procedures are successful in 80-90% of the cases. Percutaneous transhepatic drainage serves as an alternative or complementary procedure to the endoscopic approach. Virtually every patient can be treated in this way when surgery is contraindicated or impossible. Endoscopic stenting is equally effective in relieving jaundice, but has a lower mortality rate and is associated with a shorter hospital stay than biliary surgery. Patients with tumorous obstruction of the liver hilum live significantly less long than those with cancerous occlusion of the hepatocholedochal duct. In the case of bile duct cancer, non-surgical drainage procedures can be combined with endoscopic or transhepatic irradiation employing 192-iridium for intraluminal irradiation; further studies are, however, needed. Endoscopy of the biliary tract (cholangioscopy) is available via the papilla of Vater and through the liver, and may in the future expand our diagnostic and therapeutic possibilities for the treatment of malignant biliary disorders.