[Biliary stenting for hepatobiliary-pancreatic disease].

ABSTRACT

Since 1990, expandable metallic stents (EMS) have been used in biliary obstruction, which are thinner than the plastic endoprosthesis and can secure sufficient biliary tract. EMS treatment improves the prognosis of patients with unresectable malignant biliary obstruction. Several types of stent are available, and each has its own characteristics of expansion, flexibility, visibility, shorting, and size variation. Those characteristics must be taken into account when selecting a stent for individual patients. In the case of hepatic hilar obstruction, more than one EMS is needed and the position of stent placement is important. For bile duct cancer, stents should be placed in a side-by-side or end-to-side position, because in these cases the tumor affects in-growth through the stent, so repeat biliary drainage and stenting would be needed. EMS treatment is sometimes used for stenosis of the portal vein, but stent placement is not effective for chronic stenosis with collateral circulation. With the development of stenting instruments, biliary endoprosthesis has become safer and easier. But we must not forget that stent treatment is a palliative treatment and consider the indications for and selection of the stent carefully.