Abstract
The present review describes the various indications of biliary stent placement in patients with biliary malignancies. It deals in depth with biliary accesses and their effectiveness, as well as with the use of different stents according to lesion type and expected patient survival. For liver hilum lesions, which are somewhat more complex, the usefulness of and need for unilateral or bilateral drainage is assessed, as it is the most appropriate method. All in all, this is an up-to-date literature review that may help clinicians in their daily decision-making, as well as to improve and optimize patient outcomes.
Highlights
The etiology of malignant biliary stenosis varies according to localization
Among liver hilum malignancies primary cholangiocarcinoma is the most common one, whereas pancreatic adenocarcinoma predominates in the distal bile duct [1] (Table I)
The key goal for stent placement is palliative in nature, but the procedure is increasingly indicated as a preoperative measure for surgery with curative intent, or to achieve biliary patency in patients undergoing cancer therapy who will subsequently be reassessed and screened for surgery
Summary
The etiology of malignant biliary stenosis varies according to localization. Jaundice reflects an advanced stage of disease and is a marker of poor prognosis with scarce curative potential. In this setting, the key goal for stent placement is palliative in nature, but the procedure is increasingly indicated as a preoperative measure for surgery with curative intent, or to achieve biliary patency in patients undergoing cancer therapy who will subsequently be reassessed and screened for surgery. Before the endoscopic procedure for biliary stent placement we must assess a number of factors besides the neoplasm itself: patient clinical status, life expectancy, and stent indication, considering cost-effectiveness
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