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ERCP in Malignancy Management_AMANINDER DHALIWAL

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The article "Strictures and Strategies: ERCP in Malignancy Management" by Dr. Amaninder Dhaliwal explores the complexities and strategies involved in managing biliary hilar obstructions, particularly those caused by malignancies such as cholangiocarcinoma. It outlines the differential diagnoses of hilar obstruction, including both malignant and benign causes, and emphasizes the importance of thorough workup using laboratory tests, imaging, and tissue sampling to confirm diagnoses. <br /><br />The article discusses the challenges and strategies associated with stenting hilar obstructions, a procedure that can enhance patients' quality of life and prognosis, and facilitate oncologic treatments. It highlights the technical challenges due to patient variability and emphasizes evolving therapies and local expertise.<br /><br />A significant focus is on the choice between plastic and metal stents (SEMS), with studies favoring SEMS for their longer patency, fewer complications, and cost-effectiveness. It also explores the debate between unilateral vs. bilateral stenting, recommending a strategy based on liver volume drainage and the risk of cholangitis.<br /><br />The article delves into advanced techniques, such as radiofrequency ablation (RFA), which have emerged as effective for managing malignant hilar strictures. Real-world case studies are provided to illustrate complex hilar stricture drainage, emphasizing the importance of cross-sectional imaging and multidisciplinary planning to optimize outcomes.<br /><br />Lastly, the article offers guiding principles for stenting, such as avoiding drainage of non-dilated ducts and minimizing contrast injections into segments not intended for drainage. These strategies aim to maximize patient outcomes in what are often technically challenging procedures, suggesting that when in doubt, referral to tertiary centers can be beneficial.

Keywords

ERCP

biliary hilar obstructions

cholangiocarcinoma

stenting strategies

metal stents

unilateral vs bilateral stenting

radiofrequency ablation

multidisciplinary planning

malignant hilar strictures

tertiary referral