The majority (70–85%) of biliary strictures—a narrowing of the bile ducts—are associated with malignancy, particularly pancreatic adenocarcinoma and cholangiocarcinoma, and are unresectable at presentation. Management options for distal biliary obstruction depend on several clinical factors, including the underlying cause and the location and complexity of the stricture. Endoscopic stent placement has lower morbidity and mortality rates compared with more invasive surgical options and is usually the first-line treatment to clear the blockage or allow the bile duct to drain internally. There are several stenting techniques to treat stenosis, but the current quality of evidence regarding the approach for different etiologies mostly ranges from moderate to low, and there is a lack of patient-specific guidelines regarding treatment decisions and for optimizing clinical outcomes. This review describes recent developments in stent technology and distal biliary stricture management, particularly endoscopic ultrasonography-guided drainage, and synthesizes findings from clinical trials and emerging research to highlight the role of patient-specific factors, such as anatomy and comorbidities, in tailoring treatment strategies. The integration of trial evidence into clinical practice paves the way for more effective and personalized care while addressing current knowledge gaps. Future research directions are identified to advance the development of innovative stent designs, enhance the quality of life, and improve long-term outcomes for patients with biliary strictures.
大多数（70-85%）胆道狭窄——即胆管变窄——与恶性肿瘤相关，尤其是胰腺癌和胆管癌，且在确诊时通常已无法手术切除。远端胆道梗阻的治疗方案取决于多种临床因素，包括潜在病因、狭窄位置及复杂程度。相较于侵入性更强的外科手术，内镜下支架置入术具有较低的发病率和死亡率，通常是清除阻塞或实现胆管内引流的一线治疗方案。目前存在多种支架置入技术用于治疗狭窄，但针对不同病因治疗方法的现有证据质量大多处于中低水平，且缺乏针对患者个体化治疗决策及优化临床结局的指导原则。本综述阐述了支架技术及远端胆道狭窄治疗的最新进展，特别是超声内镜引导下的引流技术，并通过整合临床试验及新兴研究成果，强调解剖结构、合并症等患者个体因素在制定个体化治疗策略中的重要作用。将试验证据融入临床实践为更有效、更个体化的治疗铺平道路，同时弥补当前知识空白。本文还提出了未来研究方向，以推动创新支架设计的发展，提升患者生活质量，并改善胆道狭窄患者的长期预后。
肿瘤(癌症)患者之家