Mocan T, Horhat A, Mois E, Graur F, Tefas C, Craciun R, Nenu I, Spârchez M, Sparchez Z. Endoscopic or percutaneous biliary drainage in hilar cholangiocarcinoma: When and how? World J Gastrointest Oncol 2021; 13(12): 2050-2063 [PMID: 35070041 DOI: 10.4251/wjgo.v13.i12.2050]
Corresponding Author of This Article
Adelina Horhat, MBBS, Research Associate, Third Medical Department, "Iuliu Hatieganu" University of Medicine and Pharmacy, Croitorilor, no 21, Cluj-Napoca 400162, Romania. adelinahorhat25@gmail.com
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Minireviews
Open-Access Policy of This Article
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/
Tudor Mocan, Adelina Horhat, Emil Mois, Florin Graur, Cristian Tefas, Rares Craciun, Iuliana Nenu, Zeno Sparchez, Third Medical Department, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca 400162, Romania
Tudor Mocan, Adelina Horhat, Emil Mois, Florin Graur, Cristian Tefas, Rares Craciun, Iuliana Nenu, Institute for Gastroenterology and Hepatology, Cluj-Napoca 400162, Romania
Mihaela Spârchez, Second Pediatric Department, University of Medicine and Pharmacy, "Iuliu Hatieganu", Cluj-Napoca 400162, Romania
Author contributions: Mocan T and Sparchez Z contributed study conception and design; Mocan T and Horhat A designed the figures and tables; Mois E, Graur F, Tefas C, Craciun R, Nenu I and Spârchez M contributed draft manuscript preparation; Mocan T and Sparchez Z provided critical comments and coordinated the writing of the paper; all authors reviewed the results and approved the final version of the manuscript.
Conflict-of-interest statement: The authors have nothing to disclose.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (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/
Corresponding author: Adelina Horhat, MBBS, Research Associate, Third Medical Department, "Iuliu Hatieganu" University of Medicine and Pharmacy, Croitorilor, no 21, Cluj-Napoca 400162, Romania. adelinahorhat25@gmail.com
Received: February 28, 2021 Peer-review started: February 28, 2021 First decision: April 19, 2021 Revised: April 28, 2021 Accepted: October 12, 2021 Article in press: October 12, 2021 Published online: December 15, 2021 Processing time: 289 Days and 1.7 Hours
Abstract
Hilar cholangiocarcinoma (hCCA) is a primary liver tumor associated with a dim prognosis. The role of preoperative and palliative biliary drainage has long been debated. The most common techniques are endoscopic retrograde cholangiopancreatography (ERCP) and percutaneous transhepatic biliary drainage (PTBD); however, recently developed endoscopic ultrasound-assisted methods are gaining more atention. Selecting the best available method in any specific scenario is crucial, yet sometimes challenging. Thus, this review aimed to discuss the available techniques, indications, perks, pitfalls, and timing-related issues in the management of hCCA. In a preoperative setting, PTBD appears to have some advantages: low risk of postprocedural complications (namely cholangitis) and better priming for surgery. For palliative purposes, we propose ERCP/PTBD depending on the experience of the operators, but also on other factors: the level of bilirubin (if very high, rather PTBD), length of the stenosis and the presence of cholangitis (PTBD), ERCP failure, or altered biliary anatomy.
Core Tip: Hilar cholangiocarcinoma (hCCA) is a primary tumor of the liver with dim prognosis. The role of biliary drainage in curative and palliative setting has long been debated. Endoscopic retrograde cholangiopancreatography (ERCP) and percutaneous transhepatic biliary drainage (PTBD) as the most commonly used techniques. This review will highlight the available techniques, their indication, advantages or drawbacks, and also timing in the management of hCCA. In a preoperative setting, PTBD appears to win the argument as there is a lower risk of postprocedural complications and better priming for surgery. For palliative purposes, we propose ERCP/PTBD depending on the experience of the operators, biological and anatomy factors, and the presence of cholangitis.
