Hilar strictures - clear management strategies start to emerge.

摘要

The issues regarding hilar strictures revolve around the inability to easily access and drain the biliary tree. Because the survival rate is so low, the primary modality of therapy should be endoscopic drainage. Percutaneous drainage, although demonstrated to be successful (1-4), tends to be more painful and often requires hospital admission, which can be avoided if the initial endoscopic therapy is successful. The drainage of a single side of the biliary tree is technically easier but may not result in adequate resolution of jaundice and, additionally, may increase the risk of cholangitis (particularly if injected contrast remains poorly drained in the opposing side). The placement of bilateral stents can be technically difficult but results in improved flow and less cholangitis. However, this offers no survival benefit and may require more endoscopic procedures.