Current Status of Endoscopic Biliary Drainage in Patients with Distal Malignant Biliary Obstruction

Abstract

Distal malignant biliary obstruction is caused by various malignant diseases that require biliary drainage. In patients with operable situations, preoperative biliary drainage is required to control jaundice and cholangitis until surgery. In view of tract seeding, endoscopic biliary drainage is the first choice. Since neoadjuvant therapies are being developed, the time to surgery is increasing, especially in pancreatic cancer cases. Therefore, it requires long stent patency. Recently, preoperative biliary drainage using self-expandable metal stents has been reported as a useful modality to secure long stent patency. In patients with unresectable distal malignant biliary obstruction, self-expandable metal stent is the first choice for maintaining long stent patency. Although there are many comparison studies between a covered and an uncovered self-expandable metal stent, their use is still controversial. Recently, endoscopic ultrasound-guided biliary drainage has been performed as an alternative treatment. The clinical success and stent patency are favorable. We should take into consideration that both endoscopic retrograde cholangiopancreatography-guided biliary drainage and endoscopic ultrasound-guided biliary drainage have advantages and disadvantages and chose the drainage method depending on the patient’s situation or the expertise of the endoscopist. Here, we discuss the current status of endoscopic biliary drainage in patients with distal malignant biliary obstruction.

EUS-Guided Choledochoduodenostomy after Failed Endoscopic Retrograde Cholangiopancreatography in Distal Malignant Biliary Obstruction

“…EUS-CDS has emerged as an alternative to PTBD in cases of impossibility or failure of biliary drainage by ERCP. Since its introduction, important technical upgrades were observed, particularly with the emergence of the LAMS, the development of smaller stents – 6 and 8 mm – suitable for biliary drainage and, more recently, the addition of the electrocautery tip that allows direct fistulotomy within the bile duct, avoiding guidewire manipulation and biliary tract dilation [ 11 ].…”

Distant organ metastasis patterns in lung cancer patients with pancreatic metastasis – a cluster analysis

“…Hepatobiliary stenosis due to pancreatic metastasis makes it difficult to select hepatic metabolic antitumour agents, which might result in limited treatment options. However, with the recent spread of treatments for hepatobiliary tract stenosis, such as stent placement, the number of patients who can receive optimal lung cancer drug treatment is increasing [11,12]. With these advances in treatment, we once again focused on lung cancer and pancreatic metastasis and performed a cluster analysis of metastasis patterns in patients with pancreatic metastasis.…”

“…Although rare, pancreatic metastasis might cause obstruction of the biliary tract, limiting the administration of antitumour drugs that are metabolized in the liver and excreted from the biliary system [7][8][9][10]. With the widespread use of treatments such as biliary stents, restrictions on these anticancer drugs for lung cancer have been removed in a significant number of patients, and improvement in prognosis is expected [11,12]. In patients with lung cancer, metastasis to the pancreas might occur during dissemination to multiple organs, but this is not always the case, and it seems that there are organs that frequently metastasize at the same time [4].…”

Advanced Endoscopic Palliation of Unresectable Periampullary Carcinoma: A Systematic Review

“…Recent extensive review done by Tanisak et al [34] did not find clinically and statistically significant procedure related complications (cholangitis, pancreatitis, cholecystitis, bleeding) in covered versus uncovered SEMS [30] [31] [35] [36] [37]. The rate of recurrent biliary obstruction was clinically and statistically significant in uncovered SEMS was only shown by prospective randomised study done by Isayama et al [30] wheras all other studies [31] [35] [36] [37] did not show significant differences.…”