Table 1. Clinical guidelines for biliary stent placement9 .
| Malignant disease | Benign disease | |||
|---|---|---|---|---|
| Sphincterotomy is not necessary for inserting a single plastic stent or a SEMS, but may facilitate more complex procedures. | Sphincterotomy is not necessary for inserting a single plastic stent or a SEMS, but may facilitate more complex procedures | |||
| Malignant hilar obstruction | Malignant non-hilar biliary obstruction | Benign biliary stricture | Biliary leak | Refractory choledocolithiasis |
| 1. CT or MRI to assess resectability of malignancy 2. Endoscopic drainage is first line therapy 3. Unilateral drainage is associated with higher mortality compared with bilateral drainage 4. Drainage >50% of the liver volume is associated with longer survival 5. If there is no definitive management decision, plastic stenting is indicated |
1. Life expectancy <4 months=plastic stents (10F Polyethyelene) 2. Life expectancy >4 months=SEMS (covered=uncovered) 3. If there is no definitive management decision, plastic stenting is indicated 4. SEMS should be considered in patients undergoing other therapies 5. Preoperative drainage of resectable hilar biliary obstruction is indicated, in acute cholangitis, or in severe pruritus with a delay in surgery |
1. Multiple plastic stents may provide longer biliary patency rates. 2. Polyethylene stents decompress better than Teflon-made stents 3. Avoid uncovered biliary SEMS 4. Covered and partially covered SEMS use still unclear |
1. ERCP should be used to locate leak 2. If no lesion can be identified, plastic biliary stent placement without sphincetrotomy is recommended 3. Remove stent within 4 to 8 weeks. At time of stent removal, cholangiography and duct cleansing should be done. |
1. If stones are irretrievable after ERCP with lithotripsy, or balloon dilatation, plastic stents are effective to drain bile ducts long term 2. Ursodeoxycholic acid or terpene can be considered for stone dissolution |
SEMS, self-expanding metal stents; CT, computed tomography; MRI, magnetic resonance imaging; ERCP, esophageal retrograde cholangiopancreatography.