Inoperable Perihilar (Hilar) Cholangiocarcinoma — What to Do When ERCP/PTC Biliary Stenting Fails to Relieve Jaundice
Perihilar (hilar) cholangiocarcinoma, not distal, with inoperable disease. Proximal malignant tract obstruction causes biliary obstruction and obstructive jaundice. The obstruction has not been adequately relieved by conventional biliary drainage.
Palliative biliary stenting with an uncovered self-expanding metal stent (SEMS) placed during ERCP with selective duct cannulation, or via percutaneous transhepatic cholangiography (PTC) — unilateral or bilateral — did not achieve a meaningful reduction of hyperbilirubinaemia to the level required for chemotherapy to be offered. This failure is the trigger for escalation to the next approach.
When ERCP and PTC routes have not achieved adequate biliary decompression, an endoscopic ultrasound-guided approach to drain the obstructed intrahepatic ductal system is a key option — the complete protocol specifies which technique and the precise procedural criteria that apply.
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.
- Given the relatively close anatomical relationship between left lateral section of liver and lesser curve of gastric body, drainage of the obstructed intrahepatic ductal system can be achieved by EUS guided hepaticogastrostomy.