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2016 ; 2016
(ä): 3296801
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Malignant Biliary Obstruction: Evidence for Best Practice
#MMPMID26981114
Pu LZ
; Singh R
; Loong CK
; de Moura EG
Gastroenterol Res Pract
2016[]; 2016
(ä): 3296801
PMID26981114
show ga
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.