Endoscopic “crossroads” in the management of malignant hilar strictures

Excerpt

Malignant biliary strictures can result from primary or metastatic disease processes of the intrahepatic or extrahepatic duct(s) [1]. Hilar cholangiocarcinomas are the most common type of primary extrahepatic bile duct cancers occurring at or near the junction of the right and left hepatic ducts or common hepatic duct. The modified Bismuth–Corlett system classifies such tumor into four types based on the extent of these lesions (types 1–4). These can present with symptoms of biliary obstruction, and accurate diagnosis and staging are needed for further management. The majority of hilar lesions are advanced and unresectable at the time of diagnosis, requiring palliative management. Palliative biliary drainage is effective in relieving obstructive symptoms, improving quality of life though there is no benefit on survival [2]. An endoscopic approach may be preferred to surgical or percutaneous methods and depends on the extent of the tumor and operability of the patient. …