Endoscopic biliary stenting for unresectable malignant hilar obstruction.

Area of Science:

• Gastroenterology
• Interventional Endoscopy
• Oncology

Background:

• Unresectable malignant hilar biliary obstruction (UMHBO) requires palliative biliary drainage to enhance quality of life and prognosis.
• Endoscopic biliary drainage is a primary treatment, with self-expanding metal stents (SEMSs) favored over plastic stents (PSs) for longer life expectancies (>3 months).
• Treating UMHBO endoscopically presents significant challenges compared to distal obstructions, lacking a definitive consensus on optimal methods due to limited large-scale trials.

Purpose of the Study:

• To review and assess optimal stenting strategies for unresectable malignant hilar biliary obstruction (UMHBO).
• To guide clinical practice by evaluating key aspects of biliary drainage in UMHBO.
• To highlight ongoing technological advancements in stenting devices for UMHBO.

Main Methods:

• Literature review of previous studies on biliary drainage for UMHBO.
• Analysis of stent types: plastic stents (PSs) versus self-expanding metal stents (SEMSs).
• Evaluation of drainage strategies: unilateral versus bilateral stent deployment and bilateral stenting techniques (stent-in-stent vs. side-by-side).

Main Results:

• Self-expanding metal stents (SEMSs) are generally preferred for patients with a life expectancy over three months.
• The choice between unilateral and bilateral stenting depends on the liver volume requiring drainage.
• Different bilateral stenting methods, such as stent-in-stent and side-by-side, offer varied approaches to complex hilar obstructions.

Conclusions:

• Optimal stenting strategy for UMHBO involves careful consideration of stent type, liver volume, and deployment technique.
• Technological advancements are continuously improving stenting devices for UMHBO.
• Further research, including large-scale randomized controlled trials, is needed to establish a definitive consensus on the best stenting methods for UMHBO.