Percutaneous Metallic Stent Placement Effectiveness Compared to ERCP in Hilar and Lower Malignant biliary obstruction

Abstract

he management of malignant biliary obstruction of the liver is a challenging clinical problem. Because achieving a complete cure is rare and life expectancy is usually short, palliation of symptoms is often the best option for patients with this condition. Biliary decompression can be achieved through surgical bypass or nonsurgical methods. Recent advances in therapeutic endoscopy and interventional radiology have generally replaced surgical treatment, with its high operative risks. These effective and relatively non-invasive modalities have become the standard of care for palliation of malignant obstructive jaundice. Percutaneous stenting can be used as an alternative to endoscopic retrogradecholangio-pancreatography (ERCP) or when ERCP is unavailable or unsuccessful due to anatomical variations or technical difficulty. In conclusion, the percutaneous approach for stent insertion should be considered as the initial method of palliation for patients with advanced and difficult Bismuth types III and IV HC because of its higher procedural success rate and comparable clinical outcomes.

Moreover, if an endoscopic approach fails, sequentially performing percutaneous drainage should be conducted as soon as possible to help prevent cholangitis, thereby reducing patient morbidity and mortality (Jang et al., 2017).