Endoscopic Biliary Drainage in Malignant Biliopancreatic Strictures: Clinical Characteristics and Therapeutic Management

Abstract

Background: Malignant biliopancreatic strictures are a frequent cause of obstructive jaundice and are associated with poor prognosis. Their management remains complex, particularly in cases of hilar involvement, advanced disease, or poor performance status. Endoscopic biliary drainage plays a key role in their management. Aim: The aim of this study is to describe the clinical, biological, radiological, and endoscopic characteristics of malignant biliopancreatic strictures and to evaluate the outcomes of Endoscopic retrograde cholangiopancreatography (ERCP)-guided biliary drainage in routine clinical practice. Methods: A retrospective descriptive study was conducted including patients with confirmed malignant biliopancreatic strictures who underwent ERCP between January 2020 and September 2024. Clinical data, laboratory findings, imaging results, etiological diagnoses, and endoscopic outcomes were analyzed. Results: A total of 39 patients were included (mean age 66 years, male-to-female ratio 2.9). Cholestatic jaundice was present in all patients. Pancreatic cancer was the most frequent etiology (43.6%), followed by cholangiocarcinoma (20.5%). ERCP was technically successful in 82.1% of cases, with biliary drainage achieved mainly using metallic or plastic stents. Radiological drainage was required in cases of ERCP failure. Conclusion: Malignant biliopancreatic strictures are most commonly caused by pancreatic and biliary malignancies and are often diagnosed at an advanced stage. ERCP-guided biliary drainage is effective and remains the cornerstone of management in routine clinical practice.