Bilateral metallic stenting in malignant hilar obstruction.

[cholangiocarcinoma]

Endoscopic palliative biliary drainage is considered as a gold standard treatment in advanced or inoperable hilar cholangiocarcinoma . Also , metal stents are preferred over plastic stents in patients with >3 months life expectancy . However , the endoscopic intervention of advanced hilar obstruction is often more challenging and complex than that of distal malignant biliary obstructions . In this literature review , we describe the issues commonly encountered during endoscopic unilateral (single ) versus bilateral (multiple ) biliary stenting for malignant hilar obstruction . Also , we provide technical guidance to improve the technical success rates and patient outcomes , focusing on bilateral metallic stenting techniques such as stent-in -stent or side-by -side deployment .