Type:
Educational Exhibit
Keywords:
Stents, Drainage, Cholangiography, Percutaneous, Oncology, Interventional non-vascular, Biliary Tract / Gallbladder, Cancer, Multidisciplinary cancer care
Authors:
A. Aguado, J. Elejondo Oddo, F. J. Barba Tamargo, M. LETURIA ETXEBERRIA, M. Gredilla, A. Serdio, I. Prieto Argarate, F. J. Loyola Echaniz, S. Merino Landaluce; San Sebastián/ES
DOI:
10.26044/ecr2019/C-2456
Background
Most patients with hepatic hilar malignancy are not candidates for curative resection at initial presentation.
In these cases,
palliative biliary drainage may be a reasonable option to relieve symptomatic jaundice,
prevent cholangitis and preserve liver function.
Currently,
endoscopic drainage is considered the primary treatment but can it be technically challenging in complex hilar tumors,
for which percutaneous drainage is recommended.
SEMS have shown to be superior to plastic stents for palliation in patients with hilar malignancy,
with longer patency and reduced re-intervention.
The main factor associated with effective drainage is the liver volume drained.
The target for palliative stenting should be the drainage of more than 50%,
with a minimum requirement of 20% of the liver volume.
In most patients,
a unilateral stent will be enough to palliate symptoms and improve biochemical parameters.
However,
in some cases bilateral or multisegmental stenting will be necessary to achieve an adequate response.