Biliary stenting for hilar malignant biliary obstruction

Dig Endosc. 2020 Jan;32(2):275-286. doi: 10.1111/den.13549. Epub 2019 Dec 18.


Although endoscopic intervention is the mainstay for palliation of malignant biliary obstruction, a percutaneous approach has been preferred, particularly in patients with advanced high-grade hilar malignant biliary obstruction, because of the technical difficulty and risk of complications. However, recently, primary endoscopic palliation using plastic or metal stents has had higher technical and clinical success with fewer adverse events than the percutaneous approach. Endoscopic interventions are being done more and more frequently because of advances in metal stents, accessories, and techniques. However, several concerns, such as optimal stent type, number, and deployment method, remain to be resolved. Therefore, we reviewed the literature in order to identify the optimal biliary stenting strategy for patients with hilar malignant biliary obstruction, focusing on stent type (plastic vs metal), number (unilateral [single] vs bilateral [multiple]), and deployment method (stent-in-stent vs stent-by-stent).

Keywords: biliary; drainage; hilar; obstruction; stent.

Publication types

  • Review

MeSH terms

  • Aged
  • Bile Duct Neoplasms / complications
  • Bile Duct Neoplasms / diagnostic imaging
  • Bile Duct Neoplasms / surgery*
  • Cholangiopancreatography, Endoscopic Retrograde / methods*
  • Cholestasis / diagnostic imaging
  • Cholestasis / etiology
  • Cholestasis / surgery*
  • Female
  • Humans
  • Male
  • Metals
  • Middle Aged
  • Neoplasm Invasiveness / pathology
  • Neoplasm Staging
  • Palliative Care / methods*
  • Plastics
  • Prognosis
  • Prosthesis Design
  • Risk Assessment
  • Stents*
  • Survival Rate
  • Treatment Outcome


  • Metals
  • Plastics