The role of endoscopic treatment in palliative care of hilar malignant strictures

Abstract

Malignant hilar strictures (MHS) are caused by a heterogeneous
group of tumours. They have an extremely poor
prognosis, with the vast majority of patients dying in the
first year after the diagnosis. Palliation of patients with
MHS is a difficult clinical problem with little consensus
regarding the optimal treatment approach. The choices for
palliation of jaundice in these patients include surgical
bypass and percutaneous or endoscopic drainage. Endoscopic
endoprothesis insertion has a high successful drainage
rate, is associated with acceptable morbidity and low
procedure related mortality. Endoscopic biliary stenting can
offer effective palliation of jaundice, improve the global
quality of life and a variety of symptoms. Those working
with endoscopic biliary stenting need to be familiar with
the indications, the endoscopic difficulties and be able to
recognise and deal competently with the complications. In
this article we review the experience with therapeutic ERCP
in the management of MHS.