| Theme | Biliopancreatic Drainage and Stenting | |
|---|---|---|
| Title | Endoscopic Strategy for Biliary Strictures | |
| Publish Date | 2012/04 | |
| Author | Kensuke Kubota | Division of Gastroenterology, Yokohama City University Hospital |
| Author | Seitaro Watanabe | Division of Gastroenterology, Yokohama City University Hospital |
| Author | Kunihiro Hosono | Division of Gastroenterology, Yokohama City University Hospital |
| Author | Noritoshi Kobayashi | Division of Gastroenterology, Yokohama City University Hospital |
| Author | Itaru Endo | Division of Surgery, Yokohama City University, Graduate School of Medicine |
| Author | Atsushi Nakajima | Division of Gastroenterology, Yokohama City University Hospital |
| [ Summary ] | Until recently, endoscopic metal stents have been deployed for unresectable pancreatico-biliary cancer (PBC). Plastic stents are used for resectable conditions as well. At this time, neoadjuvant chemotherapy is performed for patients with potentially resectable PBC. New endoscopic strategies have been tried, such as inside stents for patients with biliary stricture in the hilar part and covered metallic stents for patients with biliary stricture in the lower section. However, evidence to support implementation of these modalities is inconclusive. Usage depends on the conditions observed based on imaging provided through multi-detector computed tomography and/or cholangiograms. A determination must be made as to whether multi-stents or single-stents are preferable for patients with Klatskin tumors. We can employ metal stents above the ampulla of Vater depending on the extent of the lesion in the bile duct. Covered metal stents may be preferable in 6 cm lengths. These should be implemented after we perform sphincterotomies to reduce the risk of post-procedure pancreatitis. | |