Important pointers

Routine pre-operative stenting is not advised in those fit for surgery.

Metallic stenting may be attempted when surgery is being planned in the future for temporarily unfit patients.

Endoscopic stenting is preferred over surgical bypass for palliation of symptoms.

Indications

1. Unresectable Pancreaticobiliary malignancy
2. Metastatic disease with Obstructive jaundice
3. Unfit for surgery
4. Symptomatic jaundice, pruritus and cholangitis
5. Biliary decompression prior to chemotherapy

References

National Institute for Health and Care Excellence. (2018).
Pancreatic cancer in adults: Diagnosis and management (NG85). NICE.
https://www.nice.org.uk/guidance/ng85

Dumonceau, J.-M., Tringali, A., Papanikolaou, I. S., Blero, D., Mangiavillano, B., Schmidt, A., Vanbiervliet, G., Costamagna, G., & Devière, J. (2018).
Endoscopic biliary stenting: Indications, choice of stents, and results: European Society of Gastrointestinal Endoscopy (ESGE) clinical guideline. Endoscopy, 50(9), 910–930.

Qumseya, B. J., Sultan, S., Bain, P., Jamil, L. H., Jacobson, B. C., Lee, L. S., & Wani, S. (2021).
ASGE guideline on the role of endoscopy in the management of malignant hilar obstruction. Gastrointestinal Endoscopy, 94(2), 222–234.