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Endoscopic Stenting in Hilar Cholangiocarcinoma: When, How, and How Much to Drain?
Hilar cholangiocarcinoma (HCCA) involves a complex anatomical region where bile ducts, arteries, and veins create a complex network. HCCA can lead to biliary strictures at the main hepatic confluence, involving the right and left radicles. Endoscopic drainage of jaundiced patients with HCCA is chall...
Autores principales: | , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Hindawi
2019
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6874867/ https://www.ncbi.nlm.nih.gov/pubmed/31781190 http://dx.doi.org/10.1155/2019/5161350 |
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author | Tringali, Andrea Boškoski, Ivo Costamagna, Guido |
author_facet | Tringali, Andrea Boškoski, Ivo Costamagna, Guido |
author_sort | Tringali, Andrea |
collection | PubMed |
description | Hilar cholangiocarcinoma (HCCA) involves a complex anatomical region where bile ducts, arteries, and veins create a complex network. HCCA can lead to biliary strictures at the main hepatic confluence, involving the right and left radicles. Endoscopic drainage of jaundiced patients with HCCA is challenging and carries a high risk of infective complications. HCCA needs a careful multidisciplinary evaluation to assess the indication and purposes (preoperative/palliative) of the biliary drainage. Biliary drainage in HCCA needs to be planned by magnetic resonance cholangiography in order to study the biliary anatomy and perform a target drainage of the intrahepatic ducts above the malignant hilar stricture; all the opacified intrahepatic ducts above the hilar stricture must be drained to reduce septic complications. Drainage of >50% of the liver volume is important to obtain bilirubin reduction and less complications, but atrophic liver segments (identified by CT scan) do not require drainage due to the increased risk of cholangitis. When preoperative biliary drainage is planned, plastic stents must be inserted. Self-expandable metal stents are indicated for palliative purposes and should be placed only when a complete liver drainage is possible; only uncovered metal stents are indicated to drain malignant hilar strictures to avoid side-branch occlusion. |
format | Online Article Text |
id | pubmed-6874867 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2019 |
publisher | Hindawi |
record_format | MEDLINE/PubMed |
spelling | pubmed-68748672019-11-28 Endoscopic Stenting in Hilar Cholangiocarcinoma: When, How, and How Much to Drain? Tringali, Andrea Boškoski, Ivo Costamagna, Guido Gastroenterol Res Pract Review Article Hilar cholangiocarcinoma (HCCA) involves a complex anatomical region where bile ducts, arteries, and veins create a complex network. HCCA can lead to biliary strictures at the main hepatic confluence, involving the right and left radicles. Endoscopic drainage of jaundiced patients with HCCA is challenging and carries a high risk of infective complications. HCCA needs a careful multidisciplinary evaluation to assess the indication and purposes (preoperative/palliative) of the biliary drainage. Biliary drainage in HCCA needs to be planned by magnetic resonance cholangiography in order to study the biliary anatomy and perform a target drainage of the intrahepatic ducts above the malignant hilar stricture; all the opacified intrahepatic ducts above the hilar stricture must be drained to reduce septic complications. Drainage of >50% of the liver volume is important to obtain bilirubin reduction and less complications, but atrophic liver segments (identified by CT scan) do not require drainage due to the increased risk of cholangitis. When preoperative biliary drainage is planned, plastic stents must be inserted. Self-expandable metal stents are indicated for palliative purposes and should be placed only when a complete liver drainage is possible; only uncovered metal stents are indicated to drain malignant hilar strictures to avoid side-branch occlusion. Hindawi 2019-11-04 /pmc/articles/PMC6874867/ /pubmed/31781190 http://dx.doi.org/10.1155/2019/5161350 Text en Copyright © 2019 Andrea Tringali et al. http://creativecommons.org/licenses/by/4.0/ This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. |
spellingShingle | Review Article Tringali, Andrea Boškoski, Ivo Costamagna, Guido Endoscopic Stenting in Hilar Cholangiocarcinoma: When, How, and How Much to Drain? |
title | Endoscopic Stenting in Hilar Cholangiocarcinoma: When, How, and How Much to Drain? |
title_full | Endoscopic Stenting in Hilar Cholangiocarcinoma: When, How, and How Much to Drain? |
title_fullStr | Endoscopic Stenting in Hilar Cholangiocarcinoma: When, How, and How Much to Drain? |
title_full_unstemmed | Endoscopic Stenting in Hilar Cholangiocarcinoma: When, How, and How Much to Drain? |
title_short | Endoscopic Stenting in Hilar Cholangiocarcinoma: When, How, and How Much to Drain? |
title_sort | endoscopic stenting in hilar cholangiocarcinoma: when, how, and how much to drain? |
topic | Review Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6874867/ https://www.ncbi.nlm.nih.gov/pubmed/31781190 http://dx.doi.org/10.1155/2019/5161350 |
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