Role of Endoscopy in the Management of Malignant Hilar Obstruction

Patient Guideline Summary

Publication Date: May 19, 2021

Last Updated: March 3, 2023

Objective

This patient summary means to discuss key recommendations from the American Society for Gastrointestinal Endoscopy (ASGE) for the role of endoscopy in the management of malignant hilar obstruction. It is limited to adults 18 years of age and older and should not be used as a reference for children.

Overview

Note: malignant hilar obstruction describes obstruction by cancer of the ducts that drain bile from the liver.
We will use the abbreviation MHO throughout this summary to refer to malignant hilar obstruction.
Jaundice (yellow skin and whites of the eyes) may be the only symptom besides those from cancer. Note: there may also be pruritus (itching), weight loss, abdominal pain, fatigue, fever, nausea, and vomiting.
This patient summary focuses on endoscopic relief of the obstruction.

Treatment

There are two approaches to opening the obstructed duct. Each approach results in stents placed through the obstruction that restore the flow of bile:
- Percutaneous transhepatic biliary drainage (PTBD)
  - Guided by an x-ray, a needle is placed through your skin and into the bile duct. A stent or stents are threaded through the obstruction and expanded to open the channel.
- Endoscopic biliary drainage (EBD)
  - While you are anesthetized, an endoscope is inserted through your mouth and stomach. Through the endoscope, a stent or stents are inserted into the bile duct and expanded to open the channel.
- Stents can be either plastic or metal.
All decisions are based on patient preferences, disease characteristics, and local expertise.

Abbreviations

ASGE: American Society For Gastrointestinal Endoscopy
EBD: Endoscopic Biliary Drainage
MHO: Malignant Hilar Obstruction
PTBD: Percutaneous Transhepatic Biliary Drainage

Source Citation

Qumseya BJ, Jamil LH, Elmunzer BJ, Riaz A, Ceppa EP, Thosani NC, Buxbaum JL, Storm AC, Sawhney MS, Pawa S, Naveed M, Lee JK, Law JK, Kwon RS, Jue TL, Fujii-Lau LL, Fishman DS, Calderwood AH, Amateau SK, Al-Haddad M, Wani S. ASGE guideline on the role of endoscopy in the management of malignant hilar obstruction. Gastrointest Endosc. 2021 Aug;94(2):222-234.e22. doi: 10.1016/j.gie.2020.12.035. Epub 2021 May 20. PMID: 34023067.

Disclaimer

The information in this patient summary should not be used as a substitute for professional medical care or advice. Contact a health care provider if you have questions about your health.