Y-Shaped, Self-Expanding Metallic Stents (SEMS) to Drain Malignant Strictures of the Liver Hilum: Y Are They Better?

Excerpt

In the last 20 years, the prognosis of hilar cholangiocarcinoma (aka Klatskin tumor) has progressed from almost certain death to a potentially survivable lesion, thanks to advances in surgical technique, portal vein embolization, chemoradiation, and liver transplantation. Undoubtedly, the revised anatomic classification of these lesions based on vascular supply (the Bismuth classification) “jump-started” this revolution [1]. In the era dominated by a palliative approach, endoscopists were largely focused on how best to achieve relief of jaundice and itching, often a major misery for these unfortunate patients. The magnitude and quality-of-life impact of pruritus due to obstructive jaundice should never be underestimated. One of us (JB) recalls a patient with malignant biliary strictures who needed to regularly roll on a rough coconut doormat in the hospital as the principal means of relieving his dreadful itching. …