Clin Endosc.  2015 May;48(3):201-208. 10.5946/ce.2015.48.3.201.

Update on Pancreatobiliary Stents: Stent Placement in Advanced Hilar Tumors

• Jang SI
• Lee DK

• KMID: 2148567
• DOI: http://doi.org/10.5946/ce.2015.48.3.201

Abstract

Palliative drainage is the main treatment option for inoperable hilar cholangiocarcinoma to improve symptoms, which include cholangitis, pruritus, high-grade jaundice, and abdominal pain. Although there is no consensus on the optimal method for biliary drainage due to the paucity of large-scale randomized control studies, several important aspects of any optimal method have been studied. In this review article, we discuss the liver volume to be drained, stent type, techniques to insert self-expanding metal stents, and approaches for proper and effective biliary drainage based on previous studies and personal experience.

Keyword

Hilar cholangiocarcinoma; Cholangiocarcinoma; Klatskin's tumor; Palliation; Biliary stenting

MeSH Terms

Abdominal Pain
Cholangiocarcinoma
Cholangitis
Consensus
Drainage
Humans
Jaundice
Klatskin's Tumor
Liver
Pruritus
Stents*

Figure

• 

  Fig. 1 Formation of a liver abscess after insertion of a unilateral metal stent in a patient with hilar cholangiocarcinoma. (A) Inoperable papillary-type cholangiocarcinoma (white arrow) diagnosed as Bismuth type IV based on the initial computed tomography scan. (B) A self-expandable metal stent was inserted unilaterally in the left lobe via the percutaneous tract after failed endoscopic stenting. (C) The stent was occluded due to tumor in-growth after 8 months. (D) The liver abscess developed in the right lobe, the contralateral side during stent insertion.

• 

  Fig. 2 Cholangiograms demonstrating successful palliation using the percutaneous method after failed endoscopy. (A) Magnetic resonance cholangiography demonstrated a Bismuth type IV hilar malignancy, with dilation of both intrahepatic ducts. (B) The guidewire was not able to pass through the stricture site during endoscopy due to tightness. (C) An ultrasound-guided puncture at both intrahepatic ducts was successful. (D) Two self-expandable metal stents (X-type) were inserted successfully via the previous percutaneous tracts.

• 

  Fig. 3 Cholangiograms demonstrating successful palliation using the percutaneous method after failed endoscopy. (A) Magnetic resonance cholangiography demonstrated a Bismuth type IV hilar malignancy, with dilation of both intrahepatic ducts. (B) Although the guidedwire was able to pass through the stricture site, the 8-Fr metal stent delivery system could not be passed during endoscopy due to tightness. (C) An ultrasound-guided puncture in the right intrahepatic duct was successful. (D) Two self-expandable metal stents (T-type) were inserted successfully via the previous percutaneous tract.

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