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Review
. 2007 Aug 14;13(30):4042-5.
doi: 10.3748/wjg.v13.i30.4042.

Endoscopic approach to malignant strictures at the hepatic hilum

Giovanni D De Palma, Stefania Masone, Maria Rega, Immacolata Simeoli, Francesca Salvatori, Saverio Siciliano, Francesco Maione, Valerio Girardi, Marta Celiento, Giovanni Persico
Review

Endoscopic approach to malignant strictures at the hepatic hilum

Giovanni D De Palma et al. World J Gastroenterol. .

Abstract

Hilar tumors have proven to be a challenge to treat and manage because of their poor sensitivity to conventional therapies and our inability to prevent or to detect early tumor formation. Endoscopic stent drainage has been proposed as an alternative to biliary-enteric bypass surgery and percutaneous drainage to palliate malignant biliary obstruction. Prosthetic palliation of patients with malignant hilar stenoses poses particular difficulties, especially in advanced lesions (type II lesions or higher). The risk of cholangitis after contrast injection into the biliary tree in cases where incomplete drainage is achieved is well known. The success rate of plastic stent insertion is around 80% in patients with proximal tumors. Relief of symptoms can be achieved in nearly all patients successfully stented.

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Figures

Figure 1
Figure 1
Schematic representation of Bismuth classification of hilar cholangiocarcinoma.
Figure 2
Figure 2
A: Unilateral stent implantation in Bismuth type-Ihilar stricture; B: Bilateral stent implantation in Bismuth type III a hilar stricture; C: Unilateral stent implantation in Bismuth type-IV hilar stricture.
See this image and copyright information in PMC

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