Preoperative biliary drainage for hilar cholangiocarcinoma: which stent should be selected?

The controversy over whether and how to perform preoperative biliary drainage (PBD) in patients with hilar cholangiocarcinoma (HCA) remains unsettled. Arguments against PBD before pancreatoduodenectomy have recently been gaining momentum. However, the complication-related mortality rate is as high a...

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Bibliographic Details
Published in:Journal of hepato-biliary-pancreatic sciences 2011-09, Vol.18 (5), p.630-635
Main Authors: Kawakami, Hiroshi, Kondo, Satoshi, Kuwatani, Masaki, Yamato, Hiroaki, Ehira, Nobuyuki, Kudo, Taiki, Eto, Kazunori, Haba, Shin, Matsumoto, Joe, Kato, Kentaro, Tsuchikawa, Takahiro, Tanaka, Eiichi, Hirano, Satoshi, Asaka, Masahiro
Format: Article
Language:English
Subjects:
Abdominal Surgery
bilateral biliary drainage
Bile Duct Neoplasms - therapy
Bile Ducts, Intrahepatic
Cholangiocarcinoma - therapy
Drainage - instrumentation
endoscopic biliary drainage
endoscopic nasobiliary drainage
Endoscopy
Endoscopy, Digestive System - methods
Gastroenterology
Hepatology
hilar cholangiocarcinoma
Humans
Medicine
Medicine & Public Health
Mortality
preoperative biliary drainage
Preoperative Care - methods
Prosthesis Design
Stents
Surgical Oncology
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Summary:The controversy over whether and how to perform preoperative biliary drainage (PBD) in patients with hilar cholangiocarcinoma (HCA) remains unsettled. Arguments against PBD before pancreatoduodenectomy have recently been gaining momentum. However, the complication-related mortality rate is as high as 10% for patients with HCA who have undergone major liver resection, and liver failure is a major cause of postoperative death. This suggests the need for PBD to treat jaundice in HCA patients scheduled for major surgical resection of the liver and that major surgery should be performed only after the recovery of hepatic function. No definite criteria or guidelines outlining indications for PBD are currently available. In patients with HCA, PBD may be performed by either percutaneous transhepatic biliary drainage (PTBD) or endoscopic biliary drainage (EBD). No consensus, however, has been reached regarding which drainage method is more appropriate. No reported study has compared the effectiveness of PTBD, endoscopic biliary stenting (EBS), and endoscopic nasobiliary drainage (ENBD) in patients with HCA. This review summarizes the results of our study comparing the three methods and outlines the preoperative endoscopic management of segmental cholangitis (SC) in HCA patients undergoing PBD.
ISSN:1868-6974
1868-6982
DOI:10.1007/s00534-011-0404-7