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Endoscopic stenting, due to being less invasive, is feasible for most patients with biliary strictures; however, presumed efficacy should be balanced against the procedure-related morbidities for an individual patient. Self-expandable metallic stents have a longer patency, but are not retrievable. Therefore, the use of self-expandable metallic stents should be limited to those with unequivocal findings of unresectable malignancy. Plastic stents are indicated for strictures due to benign etiologies and equivocal malignancy. Endoscopic stenting for hilar biliary stricture is challenging. Bilateral hepatic drainage seems ideal but is often demanding to achieve with endoscopic technique, and contrast injection into undrained segments may pose a substantial risk for cholangitis and aggravate prognosis. Therefore, the extent of drainage should be balanced against the procedure-related complications. Preoperative magnetic resonance cholangiopancreatography may help determine feasibility of bilateral drainage or an ‘intended and selective drainage’ with a single stent and might obviate the possible morbidities.

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