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| 1 | Malignant biliary obstruction:From palliation to treatment显示文摘Malignant obstruction of the bile duct from cholan-giocarcinoma,pancreatic adenocarcinoma,or other tumors is a common problem which may cause debilitating symptoms and increase the risk of subsequent surgery.The optimal treatment-including the decision whether to treat prior to resection-depends on the type of malignancy,as well as the stage of disease.Preoperative biliary drainage is generally discouraged due to the risk of infectious complications,though some situations may benefit.Patients who require neoadjuvant therapy will require decompression for the prolonged period until attempted surgical cure.For pancreatic cancer patients,self-expanding metallic stents are superior to plastic stents for achieving lasting decompression without stent occlusion.For cholangiocarcinoma patients,treatment with percutaneous methods or nasobiliary drainage may be superior to endoscopic stent placement,with less risk of infectious complications or failure.For patients of either malignancy who have advanced disease with palliative goals only,the choice of stent for endoscopic decompression depends on estimated survival,with plastic stents favored for survival of < 4 mo.New endoscopic techniques may actually extend stent patency and patient survival for these patients by achieving local control of the obstructing tumor.Both photodynamic therapy and radiofrequency ablation may play a role in extending survival of patients with malignant biliary obstruction. | Brian R Boulay Aleksandr Birg | 2016 | World Journal of Gastrointestinal Oncology2016，8，6： | 24 |
| 2 | Current status of endoscopic biliary drainage for unresectable malignant hilar biliary strictures显示文摘The management of jaundice and cholangitis is important for improving the prognosis and quality of life of patients with unresectable malignant hilar biliary strictures(UMHBS). In addition, effective chemotherapy, such as a combination of gemcitabine and cisplatin, requires the successful control of jaundice and cholangitis. However, endoscopic drainage for UMHBS is technical demanding, and continuing controversies exist in the selection of the most appropriate devices and techniques for stent deployment. Although metallic stents(MS) are superior to the usual plastic stents in terms of patency, an extensive comparison between MS and 'inside stents', which are deployed above the sphincter of Oddi, is necessary. Which techniques are preferred remains as yet unresolved: for instance, whether to use a unilateral or bilateral drainage, or a stent-in-stent or side-by-side method for the deployment of bilateral MS, although a new cell design and thin delivery system for MS allowed us to accomplish successful deployments of bilateral MS. The development of techniques and devices for re-intervention after stent occlusion is also imperative. Further critical investigations of more effective devices and techniques, and increased randomized controlled trials are warranted to resolve these important issues. | Hironari Kato Koichiro Tsutsumi Hirofumi Kawamoto Hiroyuki Okada | 2015 | World Journal of Gastrointestinal Endoscopy2015，7，11： | 1 |
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