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World J Gastrointest Endosc. Jul 10, 2015; 7(8): 806-813
Published online Jul 10, 2015. doi: 10.4253/wjge.v7.i8.806
Endoscopic management of hilar biliary strictures
Rajiv Ranjan Singh, Virendra Singh
Rajiv Ranjan Singh, Virendra Singh, Departments of Hepatology, Post Graduate Institute of Medical Education and Research, Chandigarh 160 012, India
Author contributions: Both the authors contributed to this manuscript.
Conflict-of-interest statement: None.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Dr. Virendra Singh, MD, DM, FASGE, Professor, Department of Hepatology, Post Graduate Institute of Medical Education and Research, Sector 12, Near Punjab University, Chandigarh 160 012, India. virendrasingh100@hotmail.com
Telephone: +91-172-2756338 Fax: +91-172-2744401
Received: October 29, 2014
Peer-review started: November 2, 2014
First decision: December 12, 2014
Revised: March 26, 2015
Accepted: April 10, 2015
Article in press: April 12, 2015
Published online: July 10, 2015
Abstract

Hilar biliary strictures are caused by various benign and malignant conditions. It is difficult to differentiate benign and malignant strictures. Postcholecystectomy benign biliary strictures are frequently encountered. Endoscopic management of these strictures is challenging. An endoscopic method has been advocated that involves placement of increasing number of stents at regular intervals to resolve the stricture. Malignant hilar strictures are mostly unresectable at the time of diagnosis and only palliation is possible.Endoscopic palliation is preferred over surgery or radiological intervention. Magnetic resonance cholangiopancreaticography is quite important in the management of these strictures. Metal stents are superior to plastic stents. The opinion is divided over the issue of unilateral or bilateral stenting.Minimal contrast or no contrast technique has been advocated during endoscopic retrograde cholangiopancreatography of these patients. The role of intraluminal brachytherapy, intraductal ablation devices, photodynamic therapy, and endoscopic ultrasound still remains to be defined.

Keywords: Biliary strictures, Malignant, Benign, Endoscopy, Endoscopic retrograde cholangiopancreatography

Core tip: Management of benign or malignant hilar biliary strictures is difficult. Surgery is technically demanding for benign hilar biliary strictures and results of endoscopic management are not very satisfactory.Endoscopic palliation is preferred modality of managing malignant hilar strictures. However, it is still controversial to drain unilaterally or bilaterally. Use of contrast during endoscopic retrograde cholangiopancreatography and leaving some ducts undrained is a major problem in these patients. We have reviewed the literature on all these aspects of hilar biliary strictures.