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.