Suprapapillary versus Transpapillary Plastic Stenting for Preoperative Drainage in Hilar Obstruction: A Randomized Trial

INTERVENTION: Endoscopic drainage with placing plastic stent(s) above the papilla,Endoscopic drainage with placing plastic stent(s) across the papilla Experimental Device,Active Comparator Device Suprapapillary plastic stenting ,Transpapillary plastic stenting CONDITION: Patients with benign and malignant hilar biliary obstructions (resectable or borderline resectable) who indicated for preoperative biliary drainage ; suprapapillary stent; hilar obstruction; preoperative biliary drainage; recurrent biliary obstruction suprapapillary stent; hilar obstruction; preoperative biliary drainage; recurrent biliary obstruction PRIMARY OUTCOME: Rate of recurrent biliary obstruction 60 days Stent occlusion or stent migration, assessed by laboratory and/or imaging SECONDARY OUTCOME: Technical success Immediately after procedure Successful stent placement at indicated bile duct,Clinical success 2 weeks total bilirubin levels decrease great than 50% or normalization INCLUSION CRITERIA: 1. Age 18 to 80 years old 2. Benign and malignant hilar biliary obstructions e.g. cholangiocarcinoma, gallbladder cancer, hepatocellular carcinoma, hilar lymph node invasion, postoperative biliary strictures, primary sclerosing cholangitis, IgG4 related cholangitis, IHD stones with strictures 3. Evidence of hilar stricture from cross sectional imaging (CT or MRI) or endoscopic findings compatible with Bismuth‐Corlette classification I, II or III 4. Indicated for preoperative biliary drainage e.g. total bilirubin greater than 2 mg per dL, predicted future liver remnant less than 30 percent or delayed surgery 5. In cases of malignant hilar biliary obstruction evaluated as resectable or borderline resectable