Endoscopic palliation of unresectable hilar-cancer

Abstract

Background: Hilar cholangiocarcinoma is a relatively infrequent malignancy. Unfortunately, less than 30% of these tumors are resectable due to both, the stage of the cancer or the advanced age and comorbidities of the patients. Jaundice, cholestasis, and pain are frequent clinical features present in hilar-cancer. In patients with unresectable tumor, palliative measures as endoscopic and/or percutaneous biliary stent placement are indicated for reduction of cholestasis. However, ERCP and endoscopic stent placement across hilar strictures harbors more chance of complications, most importantly infection. Our aim was to provide a summary of published endoscopic research related to this issue and present our experiences on the endoscopic palliation of hilar- cancer. Results: Our retrospective study showed that using self-expanding metallic stents (SEMS), the survival time significantly increased [median: 2 months (0.25–48)], but he rate of septic complications were not reduced (40%), as compared to the group of patients where plastic stents were placed. The presence of sepsis proved to be an independent predictor of decreased survival. The Bismuth stage, the gender, age of the patients and the severity of initial cholestasis were not predictors of survival. The patency of SEMS were significantly longer as compared to that of plastic stents (1.1 vs. 3.1 months). Conclusions: Based on our experience and the data of the literature the following conclusions can be drawn: 1. SEMS should be used instead of plastic stents.2. Stent may be placed unilaterally and positioned distally into the most easily accessible intrahepatic duct. 3. The smallest necessary amount of contrast media should be used. 4. It is also important that contrast media should be injected only in intrehepatic segments, which will be possible to subsequently drain.