Published online Mar 15, 2016. doi: 10.4251/wjgo.v8.i3.240
Peer-review started: August 4, 2015
First decision: September 29, 2015
Revised: October 19, 2015
Accepted: December 18, 2015
Article in press: December 21, 2015
Published online: March 15, 2016
Processing time: 222 Days and 6.1 Hours
Malignant biliary strictures often present late after the window for curative resection has elapsed. In such patients, the goal of therapy is typically focused on palliation. While historically, palliative measures were performed surgically, the advent of endoscopic intervention offers minimally invasive options to provide relief of symptoms, improve quality of life, and in some cases, increase survival of these patients. Some of these therapies, such as endoscopic biliary decompression, have become mainstays of treatment for decades, whereas newer modalities, including radiofrequency ablation, and photodynamic therapy offer additional options for patients with incurable biliary malignancies.
Core tip: Palliative therapies for malignant biliary strictures are crucial for a disease that so often presents with surgical ineligibility. In this paper, we highlight both the established and more novel endoscopic palliative approaches for these types of strictures. Perhaps the most established of these therapies is endoscopic biliary deprecompression via endoscopic retrograde cholangiopancreatography (ERCP), which is notably approached differently in extrahepatic and intrahepatic strictures. In cases where traditional ERCP fails or is not feasible, endoscopic ultrasound-guided biliary drainage has quickly become the second-line intervention. Finally, we end by discussing the literature behind more novel therapies, namely intraductal radiofrequency ablation and photodynamic therapy.