Published online Jul 10, 2015. doi: 10.4253/wjge.v7.i8.806
Peer-review started: November 2, 2014
First decision: December 12, 2014
Revised: March 26, 2015
Accepted: April 10, 2015
Article in press: April 12, 2015
Published online: July 10, 2015
Processing time: 258 Days and 16.9 Hours
Hilar biliary strictures are caused by various benign and malignant conditions. It is difficult to differentiate benign and malignant strictures. Postcholecystectomy benign biliary strictures are frequently encountered. Endoscopic management of these strictures is challenging. An endoscopic method has been advocated that involves placement of increasing number of stents at regular intervals to resolve the stricture. Malignant hilar strictures are mostly unresectable at the time of diagnosis and only palliation is possible.Endoscopic palliation is preferred over surgery or radiological intervention. Magnetic resonance cholangiopancreaticography is quite important in the management of these strictures. Metal stents are superior to plastic stents. The opinion is divided over the issue of unilateral or bilateral stenting.Minimal contrast or no contrast technique has been advocated during endoscopic retrograde cholangiopancreatography of these patients. The role of intraluminal brachytherapy, intraductal ablation devices, photodynamic therapy, and endoscopic ultrasound still remains to be defined.
Core tip: Management of benign or malignant hilar biliary strictures is difficult. Surgery is technically demanding for benign hilar biliary strictures and results of endoscopic management are not very satisfactory.Endoscopic palliation is preferred modality of managing malignant hilar strictures. However, it is still controversial to drain unilaterally or bilaterally. Use of contrast during endoscopic retrograde cholangiopancreatography and leaving some ducts undrained is a major problem in these patients. We have reviewed the literature on all these aspects of hilar biliary strictures.