Interventional radiologic approach to hilar malignant biliary obstruction

Abstract

Biliary obstruction due to advanced hepatic hilar malignancy is difficult to treat, both surgically and non-surgically, using endoscopic or percutaneous drainage. Since only about 10% to 20% of patients are eligible for resection of hepatic hilar malignancies, most patients receive palliative rather than curative treatment. Percutaneous palliation of advanced hepatic hilar malignancies can be accomplished in a variety of ways. Percutaneous bilateral metallic stent placement may be a reasonable option in patients with hilar malignancies to preserve the functional volume of the liver during the course of chemotherapy and to prevent procedure-related cholangitis of a contaminated undrained lobe. Percutaneous bilateral stent-in-stent placement using wide-mesh or open-cell design stents is a feasible and effective method of achieving bilateral drainage. Moreover, unilateral covered or uncovered metallic stent placement in the lobe with patent portal vein is safe and effective method for palliative treatment in patients with contralateral portal vein occlusion caused by hilar malignancies, obviating the need for bilateral stent placement in these patients.

Percutaneous insertion of a novel dedicated metal stent to treat malignant hilar biliary obstruction

“…The primary principle behind the criteria for unresectability is the requirement for biliary and vascular reconstruction options with adequate future remnant hepatic parenchyma, as well as the presence of distant metastases or comorbidity of the patient[ 3 , 4 ]. Since only 10% to 20% of patients are suitable for resection, most of them receive palliative treatment[ 5 ]. The main aim of palliation is to re-create a connection between the biliary system and bowel to allow physiological drainage, in order to reduce pain, relieve biliary obstruction, significantly decreasing the incidence of cholangitis and allowing the administration of chemotherapy[ 6 ].…”