Management of Malignant Biliary Strictures: Experience from an Endoscopic Unit

Introduction: Malignant biliary strictures have been increasingly prevalent in recent years. These tumors are often managed palliatively, with biliary drainage being the primary therapeutic approach. Endoscopic retrograde cholangiopancreatography (ERCP) with stenting remains the gold standard technique for biliary drainage. The aim of this study is to evaluate the success and failure rates of different biliary drainage techniques and assess the success rate of biliary stent placement. Materials and Methods: This is a descriptive study conducted from March 2015 to January 2023, including all patients with tumor-related biliary strictures who underwent palliative biliary drainage. Results: 388 patients were included. The average age was 61.2 years, with a male predominance of 61.8%. 98.9% of patients presented with cholestatic jaundice. The average levels of Total Bilirubin and C-reactive protein (CRP) were 220.11 mg/l and 62.59 mg/l, respectively. The location of the obstruction was: distal common bile duct in 54.8%, proximal common bile duct in 24.1%, confluence in 18%, intrahepatic bile ducts in 2%, and middle common bile duct in 1.3% of cases. Sphincterotomy was performed in 40.3% of cases, and precut in 33.7% of cases. The overall success rate was 90.9%. 24.1% of cases underwent a repermeabilization technique: balloon dilation in 6.9% of cases, intratumoral drilling in 5.4%, with success rates of 66% and 95%, respectively. A biliary stent was placed in 86.8% of patients. In case of ERCP failure, biliary-enteric anastomosis under endoscopic ultrasound guidance was performed in 6.6% of patients, and transhepatic drainage in 1.6% of patients. Short-term complications were noted in 10.4% of cases. Clinical and biochemical evolution at 1 month after ERCP was favorable in 86% of cases. Conclusion: Palliative drainage of malignant biliary strictures primarily relies on ERCP as the first-line approach, demonstrating satisfactory success and complication rates.