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Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Endosc. Aug 25, 2015; 7(11): 1032-1038
Published online Aug 25, 2015. doi: 10.4253/wjge.v7.i11.1032
Current status of endoscopic biliary drainage for unresectable malignant hilar biliary strictures
Hironari Kato, Koichiro Tsutsumi, Hirofumi Kawamoto, Hiroyuki Okada
Hironari Kato, Koichiro Tsutsumi, Hiroyuki Okada, Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Kitaku, Okayama 700-8558, Japan
Hirofumi Kawamoto, Department of General Internal Medicine 2, Kawasaki Medical School, Kitaku, Okayama 701-0114, Japan
Author contributions: Kato H wrote the paper; Tsutsumi K analyzed the data; Kawamoto H and Okada H designed this study.
Conflict-of-interest statement: Authors declare no conflict of interests for this article.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Hironari Kato, MD, Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Okayama 700-8558, Japan. katou-h@cc.okayama-u.ac.jp
Telephone: +81-86-2357219 Fax: +81-86-2255991
Received: May 27, 2015
Peer-review started: May 31, 2015
First decision: July 1, 2015
Revised: July 28, 2015
Accepted: August 4, 2015
Article in press: August 7, 2015
Published online: August 25, 2015
Processing time: 92 Days and 18.8 Hours
Abstract

The management of jaundice and cholangitis is important for improving the prognosis and quality of life of patients with unresectable malignant hilar biliary strictures (UMHBS). In addition, effective chemotherapy, such as a combination of gemcitabine and cisplatin, requires the successful control of jaundice and cholangitis. However, endoscopic drainage for UMHBS is technical demanding, and continuing controversies exist in the selection of the most appropriate devices and techniques for stent deployment. Although metallic stents (MS) are superior to the usual plastic stents in terms of patency, an extensive comparison between MS and “inside stents”, which are deployed above the sphincter of Oddi, is necessary. Which techniques are preferred remains as yet unresolved: for instance, whether to use a unilateral or bilateral drainage, or a stent-in-stent or side-by-side method for the deployment of bilateral MS, although a new cell design and thin delivery system for MS allowed us to accomplish successful deployments of bilateral MS. The development of techniques and devices for re-intervention after stent occlusion is also imperative. Further critical investigations of more effective devices and techniques, and increased randomized controlled trials are warranted to resolve these important issues.

Keywords: Malignant hilar biliary obstruction; Biliary drainage; Metallic stents; Stent-in-stent; Side-by-side

Core tip: The development of useful surgical devices, such as plastic or metallic stents, catheters and guidewires, has allowed us to achieve successful endoscopic drainage for unresectable malignant hilar biliary strictures (UMHBS), a technically demanding procedure. However, the most appropriate method of endoscopic drainage for UMHBS remains a contentious issue: for instance, whether to use a unilateral or bilateral drainage, or a stent-in-stent or side-by-side method for the deployment of bilateral metallic stents (MS) to accomplish successful deployments of bilateral MS. Further critical investigations of more effective devices and techniques, and increased randomized controlled trials are warranted to resolve these important issues.