Inoperable Hilar Cholangiocarcinoma with Proximal Malignant Biliary Obstruction and Jaundice
This protocol covers perihilar (hilar) cholangiocarcinoma that is not amenable to surgical resection, presenting with proximal malignant tract obstruction and jaundice.
Clinical scenario
Perihilar cholangiocarcinoma (not distal); inoperable disease; proximal malignant tract obstruction with jaundice. Inoperable perihilar cholangiocarcinoma with proximal malignant tract obstruction and jaundice should be considered for palliative stenting.
Approach — partial overview
Palliative biliary stenting with a self-expanding metal stent is the interventional approach for this setting. The specific access route, stent configuration, and multidisciplinary decision framework are detailed in the full protocol.
Treatment goal
Meaningful reduction of hyperbilirubinaemia to a level where chemotherapy can be offered.
References
DOI: 10.1136/gutjnl-2023-330029
- Inoperable perihilar CCA — proximal malignant tract obstruction (PMTO) and jaundice should be considered for palliative stenting by either ERCP or PTC.
- In order to achieve a meaningful reduction of hyperbilirubinaemia (to a level where chemotherapy can be offered), an uncovered SEMS can be placed during either PTC or via ERCP with selective duct cannulation.
- An uncovered SEMS is selected to avoid cystic duct and side-branch duct occlusion.
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