Endoscopic stenting of malignant biliary strictures offers a relatively
safe and cost effective treatment for unresectable malignancies.
Jaundice and pruritis can be relieved and this is
accompanied by an improved quality of life. The main problem
with endoscopic stents is their tendency to block with time.
Attempts to extend their useful life have been made by modifying
the shape and composition of plastic stents and more
successfully, by the introduction of wide bore metal stents.
The need to drain all areas of biliary obstruction has been questioned
and the role of preoperative biliary drainage has been
explored by meta-analyses of previous trials. Palliative intervention
for obstructive jaundice in pancreatic and biliary cancer
may involve ERCP with stenting or surgery. The available
evidence does not indicate a major advantage to either alternative
so the choice may be made depending on clinical availability
and patient or practitioner preference. Predicted survival
The technical skills to perform ERCP are widely available
and this modality may be preferred to surgery in some
cases due to the lower overall resource utilization and shorter
hospitalization. The above paragraph is taken from the United
States National Institute of Health State Of The Art Conference
Statement on the role of ERCP and diagnosis therapy
published in June 2002.