Endoscopic Stenting for Unresectable Malignant Hilar Biliary Obstruction: Where Do We Stand Today? A Narrative Review
Bibliographic record
Abstract
Malignant hilar biliary obstruction (MHBO) is a complex clinical condition commonly observed in individuals with advanced cholangiocarcinoma and other hepatobiliary malignancies. Endoscopic stenting remains the primary palliative intervention for unresectable cases; however, the optimal strategy has not been clearly defined owing to the anatomical intricacies of the hilar region and the heterogeneity of disease presentation. This narrative review summarizes current evidence and ongoing debates on functional liver volume-based drainage, unilateral versus bilateral stenting, stent type selection, and above-the-papilla approaches. In addition, we highlight recent progress in endoscopic ultrasound-guided biliary drainage as a promising alternative or complementary approach when conventional transpapillary drainage proves inadequate. With recent advances in systemic therapies, including immunotherapy, patient survival has improved, underscoring the need for durable, reintervention-friendly stent strategies. Although uncovered metal stents have long been regarded as the standard for unresectable cases, their limitations in reintervention have prompted renewed consideration of both stent type and drainage technique. Robust prospective studies remain essential to establish standardized, evidence-based guidelines that optimize patient benefit and improve long-term outcomes in unresectable MHBO.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.003 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.002 | 0.001 |
| Bibliometrics | 0.003 | 0.003 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.003 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".