Palliation by endoscopic approach

Endoscopic retrograde cholangiopancreatography (ERCP) with stenting has been used in the palliation of malignant obstructive jaundice for nearly three decades [1-3]. The initial success of endoscopic internal biliary drainage [1, 2], coupled with its low invasiveness [4] as a form of palliation, led to the suggestion that it represented the treatment of choice for unresectable cholangiocarcinomas [2] over the percutaneous or surgical alternatives. Endoscopic stenting of malignant hilar strictures, however, remains a technically challenging prospect. This, along with advances in interventional radiology over the years amongst other reasons, has precluded the development of clear delineation of the ideal technique for palliating hilar cholangiocarcinomas. In most instances, the extent of the obstruction, the anatomical arrangement of the intrahepatic ducts and the available local expertise shall determine the approach.