Malignant Biliary Obstruction: Evidence for Best Practice
What should be done next? Is the stricture benign? Is it resectable? Should I place a stent? Which one? These are some of the questions one ponders when dealing with biliary strictures. In resectable cases, ongoing questions remain as to whether the biliary tree should be drained prior to surgery. I...
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| Format: | Article |
| Language: | English |
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Wiley
2016-01-01
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| Series: | Gastroenterology Research and Practice |
| Online Access: | http://dx.doi.org/10.1155/2016/3296801 |
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| author | Leonardo Zorrón Cheng Tao Pu Rajvinder Singh Cheong Kuan Loong Eduardo Guimarães Hourneaux de Moura |
| author_facet | Leonardo Zorrón Cheng Tao Pu Rajvinder Singh Cheong Kuan Loong Eduardo Guimarães Hourneaux de Moura |
| author_sort | Leonardo Zorrón Cheng Tao Pu |
| collection | DOAJ |
| description | What should be done next? Is the stricture benign? Is it resectable? Should I place a stent? Which one? These are some of the questions one ponders when dealing with biliary strictures. In resectable cases, ongoing questions remain as to whether the biliary tree should be drained prior to surgery. In palliative cases, the relief of obstruction remains the main goal. Options for palliative therapy include surgical bypass, percutaneous drainage, and stenting or endoscopic stenting (transpapillary or via an endoscopic ultrasound approach). This review gathers scientific foundations behind these interventions. For operable cases, preoperative biliary drainage should not be performed unless there is evidence of cholangitis, there is delay in surgical intervention, or intense jaundice is present. For inoperable cases, transpapillary stenting after sphincterotomy is preferable over percutaneous drainage. The use of plastic stents (PS) has no benefit over Self-Expandable Metallic Stents (SEMS). In case transpapillary drainage is not possible, Endoscopic Ultrasonography- (EUS-) guided drainage is still an option over percutaneous means. There is no significant difference between the types of SEMS and its indication should be individualized. |
| format | Article |
| id | doaj-art-7235b18a71374d388011216b13891387 |
| institution | Kabale University |
| issn | 1687-6121 1687-630X |
| language | English |
| publishDate | 2016-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | Gastroenterology Research and Practice |
| spelling | doaj-art-7235b18a71374d388011216b138913872025-02-03T01:26:14ZengWileyGastroenterology Research and Practice1687-61211687-630X2016-01-01201610.1155/2016/32968013296801Malignant Biliary Obstruction: Evidence for Best PracticeLeonardo Zorrón Cheng Tao Pu0Rajvinder Singh1Cheong Kuan Loong2Eduardo Guimarães Hourneaux de Moura3Setor de Endoscopia Gastrointestinal, Departamento de Gastroenterologia, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, 05403-000 São Paulo, SP, BrazilGastroenterology Department, Lyell McEwen Hospital, Adelaide, Haydown Road, Elizabeth Vale, SA 5112, AustraliaGastroenterology Department, Lyell McEwen Hospital, Adelaide, Haydown Road, Elizabeth Vale, SA 5112, AustraliaSetor de Endoscopia Gastrointestinal, Departamento de Gastroenterologia, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, 05403-000 São Paulo, SP, BrazilWhat should be done next? Is the stricture benign? Is it resectable? Should I place a stent? Which one? These are some of the questions one ponders when dealing with biliary strictures. In resectable cases, ongoing questions remain as to whether the biliary tree should be drained prior to surgery. In palliative cases, the relief of obstruction remains the main goal. Options for palliative therapy include surgical bypass, percutaneous drainage, and stenting or endoscopic stenting (transpapillary or via an endoscopic ultrasound approach). This review gathers scientific foundations behind these interventions. For operable cases, preoperative biliary drainage should not be performed unless there is evidence of cholangitis, there is delay in surgical intervention, or intense jaundice is present. For inoperable cases, transpapillary stenting after sphincterotomy is preferable over percutaneous drainage. The use of plastic stents (PS) has no benefit over Self-Expandable Metallic Stents (SEMS). In case transpapillary drainage is not possible, Endoscopic Ultrasonography- (EUS-) guided drainage is still an option over percutaneous means. There is no significant difference between the types of SEMS and its indication should be individualized.http://dx.doi.org/10.1155/2016/3296801 |
| spellingShingle | Leonardo Zorrón Cheng Tao Pu Rajvinder Singh Cheong Kuan Loong Eduardo Guimarães Hourneaux de Moura Malignant Biliary Obstruction: Evidence for Best Practice Gastroenterology Research and Practice |
| title | Malignant Biliary Obstruction: Evidence for Best Practice |
| title_full | Malignant Biliary Obstruction: Evidence for Best Practice |
| title_fullStr | Malignant Biliary Obstruction: Evidence for Best Practice |
| title_full_unstemmed | Malignant Biliary Obstruction: Evidence for Best Practice |
| title_short | Malignant Biliary Obstruction: Evidence for Best Practice |
| title_sort | malignant biliary obstruction evidence for best practice |
| url | http://dx.doi.org/10.1155/2016/3296801 |
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