Bilateral Biliary Drainage for Malignant Hilar Obstruction with EUS-Guided Hepaticogastrostomy and Hepaticoduodenostomy

Main RecommendationsESGE recommends against routine preoperative biliary drainage in patients with malignant extrahepatic biliary obstruction; preoperative biliary drainage should be reserved for patients with cholangitis, severe symptomatic jaundice (e. g., intense pruritus), or delayed surgery, or for before neoadjuvant chemotherapy in jaundiced patients. Strong recommendation, moderate quality evidence. ESGE recommends the endoscopic placement of a 10-mm diameter self-expandable metal stent (SEMS) for preoperative biliary drainage of malignant extrahepatic biliary obstruction. Strong recommendation, moderate quality evidence.ESGE recommends SEMS insertion for palliative drainage of of extrahepatic malignant biliary obstruction. Strong recommendation, high quality evidence. ESGE recommends against the insertion of uncovered SEMS for the drainage of extrahepatic biliary obstruction of unconfirmed etiology. Strong recommendation, low quality evidence. ESGE suggests against routine preoperative biliary drainage in patients with malignant hilar obstruction. Weak recommendation, low quality evidence.ESGE recommends uncovered SEMSs for palliative drainage of malignant hilar obstruction. Strong recommendation, moderate quality evidence.ESGE recommends temporary insertion of multiple plastic stents or of a fully covered SEMS for treatment of benign biliary strictures. Strong recommendation, moderate quality evidence.ESGE recommends endoscopic placement of plastic stent(s) to treat bile duct leaks that are not due to transection of the common bile duct or common hepatic duct. Strong recommendation, moderate quality evidence.

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Endoscopic versus Percutaneous Biliary Drainage in Palliation of Advanced Malignant Hilar Obstruction: A Meta-Analysis and Systematic Review

Canadian Journal of Gastroenterology and Hepatology ◽

10.1155/2016/4726078 ◽

2016 ◽

Vol 2016 ◽

pp. 1-8 ◽

Cited By ~ 23

Author(s):

Harsha Moole ◽

Sirish Dharmapuri ◽

Abhiram Duvvuri ◽

Sowmya Dharmapuri ◽

Raghuveer Boddireddy ◽

...

Keyword(s):

Adverse Effects ◽

Biliary Drainage ◽

Odds Ratio ◽

Meta Analysis ◽

Selection Criterion ◽

Group Versus ◽

Random Effects Models ◽

Study Selection ◽

Fixed And Random Effects ◽

Malignant Hilar Obstruction

Background. Palliation in advanced unresectable hilar malignancies can be achieved by endoscopic (EBD) or percutaneous transhepatic biliary drainage (PTBD). It is unclear if one approach is superior to the other in this group of patients.Aims. Compare clinical outcomes of EBD versus PTBD.Methods.(i) Study Selection Criterion. Studies using PTBD and EBD for palliation of advanced unresectable hilar malignancies.(ii) Data Collection and Extraction. Articles were searched in Medline, PubMed, and Ovid journals.(iii) Statistical Method. Fixed and random effects models were used to calculate the pooled proportions.Results. Initial search identified 786 reference articles, in which 62 articles were selected and reviewed. Data was extracted from nine studies (N=546) that met the inclusion criterion. The pooled odds ratio for successful biliary drainage in PTBD versus EBD was 2.53 (95% CI = 1.57 to 4.08). Odds ratio for overall adverse effects in PTBD versus EBD groups was 0.81 (95% CI = 0.52 to 1.26). Odds ratio for 30-day mortality rate in PTBD group versus EBD group was 0.84 (95% CI = 0.37 to 1.91).Conclusions. In patients with advanced unresectable hilar malignancies, palliation with PTBD seems to be superior to EBD. PTBD is comparable to EBD in regard to overall adverse effects and 30-day mortality.

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Step-wise endoscopic approach to palliative bilateral biliary drainage for unresectable advanced malignant hilar obstruction

Scientific Reports ◽

10.1038/s41598-019-48384-x ◽

2019 ◽

Vol 9 (1) ◽

Author(s):

Jin Ho Choi ◽

Sang Hyub Lee ◽

Min Su You ◽

Bang-sup Shin ◽

Young Hoon Choi ◽

...

Keyword(s):

Overall Survival ◽

Biliary Drainage ◽

Primary Outcome ◽

Progression Free Survival ◽

Plastic Stent ◽

Free Survival ◽

Sems Group ◽

Malignant Hilar Obstruction ◽

Transhepatic Biliary Drainage ◽

The Ideal

Abstract The ideal type of stent utilized at index endoscopic retrograde cholangiopancreatography (ERCP) in management of malignant hilar obstruction (MHO) remains unclear. We aimed to determine the ideal stent choice in patients with MHO. In this retrospective study, patients with unresectable MHO were separated into the plastic stent (PS) group and the self-expandable metal stent (SEMS) group. The primary outcome was the risk and rate of rescue percutaneous transhepatic biliary drainage (PTBD). The secondary outcomes were the progression-free survival, the overall survival and the PTBD-free period (days). Thirty-six patients in the PS group and 38 patients in the SEMS group were enrolled. The risk for PTBD was higher in SEMS group (HR = 2.205, 95% C.I. 0.977–4.977, P = 0.057). The rate of PTBD was significantly lower in the PS group. (22.2% vs 50.0%, P = 0.017) There were no differences in overall survival and progression-free survival (410 and 269 in the PS group, 395 and 266 in the SEMS group, P = 0.663 and P = 0.757). The PTBD-free period was significantly longer in the PS group. (836.43 vs 586.40, P = 0.039) Although comparable in clinical efficacy, utilization of PS at index ERCP may reduce patient’s discomfort by avoiding PTBD and prolonging PTBD-free period in patients with MHO.

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