[Endoscopic prosthetic treatment in stenosis of the choledochus caused by malignant disease]

Endoscopic insertion of a biliary endoprosthesis is often the treatment of choice in patients with malignant common bile duct obstruction. In experienced centers the procedure is combined with low risk and high success rates. A well known and unresolved problem is the tendency of the stents to clog within a few months, recessitating their replacement. The best survival of the stents is achieved by using the largest straight teflon stent without sideholes. Long-term treatment with antibiotics, antimicrobial impregnated stents, stents without side holes or intraductally placed stents might increase the survival of the stents. Great experience is necessary in order to ensure optimal endoscopic treatment of all the patients with malignant common bile duct obstruction and the treatment therefore should be performed in few large centers.