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ERCP Stenting for Hilar Cholangiocarcinoma

Stenting for Cholangiocarcinoma
  • Mohammad Bilal
    Affiliations
    Division of Gastroenterology & Hepatology, Minneapolis VA Medical Center, Minneapolis, MN

    Division of Gastroenterology, Hepatology & Nutrition, University of Minnesota, Minneapolis, MN
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  • Martin L. Freeman
    Correspondence
    Corresponding Author: Martin L. Freeman, MD, MACG, MASGE, Professor of Medicine and Pediatrics, Chief, Division of Gastroenterology, Hepatology and Nutrition, Associate Director, Advanced Endoscopy Fellowship, Medical Director, Islet Autotransplantation, University of Minnesota, 420 Delaware St SE, Minneapolis, MN 55455, USA, Tell: 612 625-8999; Fax: 612 625-5620
    Affiliations
    Division of Gastroenterology, Hepatology & Nutrition, University of Minnesota, Minneapolis, MN
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Published:November 18, 2021DOI:https://doi.org/10.1016/j.tige.2021.11.006

      Abstract

      Despite advances in gastrointestinal endoscopic technology, the management of malignant hilar biliary obstruction continues to be a challenge for advanced endoscopists. There has been ongoing debate regarding the optimal modality for both diagnostic and therapeutic interventions in malignant hilar obstruction. Various approaches including endoscopy, interventional radiology guided interventions and surgery are available. The management of malignant hilar biliary obstruction should include a multidisciplinary approach, and both diagnostic and therapeutic interventions should be planned based on whether patient is a candidate for curative surgical resection or not. Understanding the Bismuth-Corlette classification as well as the liver segmental anatomy is crucial for both surgical planning as well as planning endoscopic drainage. Safe and effective endoscopic drainage of malignant hilar biliary obstruction requires a multidisciplinary approach, detailed understanding of liver as well as ductal anatomy, and careful adaptation of any strategy to the individual patient's condition, anatomy, prognosis, and in collaboration with surgery, oncology, and radiology. In this article we review the anatomical concepts and technical considerations that are essential to understand while performing endoscopic retrograde cholangiopancreatography in patients with malignant hilar biliary obstruction.

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