| Although endoscopic retrograde cholangiopancreatography (ERCP) is the mainstay for palliation of biliary obstruction resulting from both malignant and benign etiologies, a therapeutic endoscopist must have a complete discernment of the etiologies, demographics, risk factors, and diagnostic techniques to develop different tailored approached to variable clinical scenarios. Benign biliary strictures have a broad extent of etiologies, most of which result in obstruction due to underlying inflammation, ischemia, and fibrosis. Malignant biliary obstruction is most commonly seen in pancreatic adenocarcinoma and cholangiocarcinoma, and the approach to stenting may be different depending on the presentation, location of the mass, and therapeutic aims. Moreover, the feasibility of ERCP for biliary drainage is not always applicable due to anatomical alterations. In addition to percutaneous transhepatic biliary drainage has been considered the alternative to this situation, endoscopic ultrasonography-guided biliary drainage typifies a reasoned choice when ERCP flunks. This content covers the access to patients with benign and malignant biliary obstruction with a focus on the optimal strategy, technical and procedural aspects of biliary stenting. |
