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Review
. 2024 May-Jun;37(3):291-302.
doi: 10.20524/aog.2024.0883. Epub 2024 Apr 29.

Endoscopic management of malignant biliary obstructions

Cecilia Binda  1 , Margherita Trebbi  1 , Chiara Coluccio  1 , Paolo Giuffrida  1 , Barbara Perini  1   2 , Giulia Gibiino  1 , Stefano Fabbri  1 , Elisa Liverani  1 , Carlo Fabbri  1
Affiliations
Review

Endoscopic management of malignant biliary obstructions

Cecilia Binda et al. Ann Gastroenterol. 2024 May-Jun.

Abstract

Malignant biliary obstruction (MBO), both distal and hilar, represents an ensemble of different clinical conditions frequently encountered in everyday practice. Given the frequent unresectability of the disease at presentation and the increasing indications for neoadjuvant chemotherapy, endoscopic biliary drainage is generally required during the course of the disease. With the widespread use of interventional endoscopic ultrasound (EUS) and the introduction of dedicated devices, EUS-guided biliary drainage has rapidly gained acceptance, together with transpapillary endoscopic biliary drainage and the percutaneous approach. This comprehensive review describes the current role of endoscopy for distal and hilar MBO supported by evidence, with a focus on the current hot topics in this field.

Keywords: Malignant biliary obstruction; biliary drainage; endoscopic retrograde cholangiopancreatography; endoscopic ultrasound-guided drainage.

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Conflict of interest statement

Conflict of Interest: Carlo Fabbri: Lecturer for Steris, Boston Scientific, Q3 Medical; Cecilia Binda: Lecturer for Steris, Boston Scientific, Q3 Medical, Fujifilm; Chiara Coluccio: Lecturer for Steris

Figures

Figure 1
Figure 1
Endoscopic drainage of DMBO. (A) TBD with SEMS; (B) EUS-guided choledocoduodenostomy with LAMS; (C) EUS-guided hepaticogastrostomy with SEMS; (D) EUS-guided gallbladder drainage DMBO, distal malignant biliary obstruction; TBD, transpapillary endoscopic biliary drainage; SEMS, self-expandable metal stent; EUS, endoscopic ultrasound; LAMS, lumen-apposing metal stent
Figure 2
Figure 2
Endoscopic drainage of HMBO. (A) TBD with bilateral stent-in-stent technique; (B) TBD with bilateral stent-by-stent technique; (C) EUS-guided hepaticogastrostomy; (D) CERES (Combined ERCP and endosonography); (E) EUS-guided hepaticoduodenostomy; (F) Bridging method HMBO, hilar malignant biliary obstruction; TBD, transpapillary endoscopic biliary drainage; EUS, endoscopic ultrasound; CERES, combined endoscopic retrograde cholangiopancreatography and EUS
Figure 3
Figure 3
Proposed algorithm for the management of distal and hilar malignant biliary obstruction CBD, common bile duct; EUS-CDS, EUS-guided choledodochoduodenostomy; TBD, transpapillary biliary drainage; EUS-RV, EUS-guided rendezvous; EUS-HGS, EUS-guided hepaticogastrostomy; EUS-AS, EUS-guided antegrade stenting; PTBD, percutaneous transhepatic biliary drainage; EUS-HDS, EUS-guided hepaticoduodenostomy; CERES, combined ERCP and endosonography
See this image and copyright information in PMC

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