| Endoscopic stenting is presently the mainstay of endoscopic palliation for biliary obstruction. Endoscopic biliary drainage using metal stents is less invasive than other palliative procedures. For malignant biliary stenosis, metal stent can provide more effective drainage, longer stent patency and less re-intervention rate comparing with plastic stent. Especially, retrieval, fully covered metal stent can be an ideal stent for malignant biliary stenosis. Although a metal stent with long patency over the intended period with no complications would be ideal, currently available stents have limitations, such as stent occlusion, cholangitis, migration, ductal injury, and tissue hyperplasia. Therefore, we need more development to be an ideal metal stent. Many developments and improvements in stent technology have been made to overcome these problems, and innovative and modified biliary metal stents have been introduced. Recently, metal stents that have additional functions, such as anti-migratory, anti-reflux, and drug-releasing properties, have also been developed and introduced. Endoscopic management for inoperable hilar malignant biliary strictures is a challenging and complex procedure. The results is improving with newly developed metal stents, especially for bilateral metal stenting. Endoscopic ultrasonography (EUS)-guided biliary drainage can be an option for failed cases of ERCP. Specialized metal stents for effective, safe, and simple EUS-guided drainage have been developed and introduced. In conclusion, metal stenting for malignant biliary stenosis is effective, can be repeated, generally safe and minimally invasive therapy. Technical development and continuous evolution of metal stent can bring the better success and long-term results. |
