Preoperative biliary drainage for hilar cholangiocarcinoma |
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Authors: | Maguchi Hiroyuki Takahashi Kuniyuki Katanuma Akio Osanai Manabu Nakahara Kazuyuki Matuzaki Shinpei Urata Takahiro Iwano Hirotoshi |
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Institution: | (1) Center for Gastroenterology, Teine-Keijinkai Hospital, 1-jo 12-chome, Maeda, Teine-ku, Sapporo 006-8555, Japan |
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Abstract: | Hilar cholangiocarcinomas grow slowly, and metastases occur late in the natural history. Surgical cure and long-term survival
have been demonstrated, when resection margins are clear. Preoperative biliary drainage has been proposed as a way to improve
liver function before surgery, and to reduce post-surgical complications. Percutaneous transhepatic biliary drainage (PTBD)
with multiple drains was previously the preferred method for the preoperative relief of obstructive jaundice. However, the
introduction of percutaneous transhepatic portal vein embolization (PTPE) and wider resection has changed preoperative drainage
strategies. Drainage is currently performed only for liver lobes that will remain after resection, and for areas of segmental
cholangitis. Endoscopic biliary drainage (EBD) is less invasive than PTBD. Among EBD techniques, endoscopic nasobiliary drainage
(ENBD) is preferable to endoscopic biliary stenting (EBS), because secondary cholangitis (due to the retrograde flow of duodenal
fluid into the biliary tree) does not occur. ENBD needs to be converted to PTBD in patients with segmental cholangitis, those
with a prolonged need for drainage, or when the extent of longitudinal tumor extension is not sufficiently well characterized. |
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Keywords: | Preoperative biliary drainage Hilar cholangiocarcinoma Percutaneous transhepatic biliary drainage Endoscopic biliary drainage Endoscopic nasobiliary drainage Endoscopic biliary stenting |
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