Endoscopic management in malignant biliary strictures: Tips and tricks

Abstract

Malignant biliary strictures (MBS) remain a challenging problem for the diagnosis and treatment, and many issues are still unresolved. We divided MBS into distal (DMBO) and proximal-hilar malignant biliary strictures (HMBO), and we discuss the actual gray zone trying to clarify the best endoscopic approach based on available published data and/or expert opinions. The available stenting techniques are analyzed to compare the effectiveness and the long-term outcomes. The advantages of metal multiple stenting over plastic stenting are discussed. The final part is dedicated to intraductal radiofrequency and photodynamic techniques to improve the patency of the stents and to reduce the need of re-stenting in this cluster of patients. Tips & tricks are discussed in the first part.