Personalized Endoscopy in Complex Malignant Hilar Biliary Strictures

Boškoski, Ivo; Schepis, Tommaso; Tringali, Andrea; Familiari, Pietro; Bove, Vincenzo; Attili, Fabia; Landi, Rosario; Perri, Vincenzo; Costamagna, Guido

doi:10.3390/jpm11020078

Cited by 6 publications

(6 citation statements)

References 98 publications

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“…Although it is less invasive compared to the percutaneous approach, selective endoscopic stenting is technically difficult and can cause severe infectious complications, such as cholangitis. Current guidelines recommend palliative drainage of malignant hilar strictures through ERCP for Bismuth types I and II, and percutaneous transhepatic biliary drainage (PTBD) or a combination of PTBD and ERCP for Bismuth types III and IV[ 8 ].…”

Section: Endoscopic Drainagementioning

confidence: 99%

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Endoscopic or percutaneous biliary drainage in hilar cholangiocarcinoma: When and how?

Mocan¹,

Horhat²,

Moiş³

et al. 2021

WJGO

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Hilar cholangiocarcinoma (hCCA) is a primary liver tumor associated with a dim prognosis. The role of preoperative and palliative biliary drainage has long been debated. The most common techniques are endoscopic retrograde cholangiopancreatography (ERCP) and percutaneous transhepatic biliary drainage (PTBD); however, recently developed endoscopic ultrasound-assisted methods are gaining more atention. Selecting the best available method in any specific scenario is crucial, yet sometimes challenging. Thus, this review aimed to discuss the available techniques, indications, perks, pitfalls, and timing-related issues in the management of hCCA. In a preoperative setting, PTBD appears to have some advantages: low risk of postprocedural complications (namely cholangitis) and better priming for surgery. For palliative purposes, we propose ERCP/PTBD depending on the experience of the operators, but also on other factors: the level of bilirubin (if very high, rather PTBD), length of the stenosis and the presence of cholangitis (PTBD), ERCP failure, or altered biliary anatomy.

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Section: Endoscopic Drainagementioning

confidence: 99%

“…Taking these into account, plastic stents are no longer considered standard of care in Bismuth III-IV type CCA, but they can still be used in Bismuth type I-II[ 8 ].…”

Section: Endoscopic Drainagementioning

confidence: 99%

Endoscopic or percutaneous biliary drainage in hilar cholangiocarcinoma: When and how?

Mocan¹,

Horhat²,

Moiş³

et al. 2021

WJGO

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“…FC-SEMS and PC-SEMS can be used for strictures not involving the hilum and when the EBD is required before the curative surgery or when the diagnostic algorithm has not been completed yet. U-SEMS should be preferred for palliative drainage, especially when multiple stents are needed avoiding, therefore, the obstruction of side branches [ 32 , 36 ].…”

Section: Jaundice and Cholangitismentioning

confidence: 99%

“…The stent-in-stent (SIS) and side-by-side (SBS) techniques are the two available options for the placement of bilateral SEMS [ 33 ]. The SIS method implies the insertion of the first SEMS over a guidewire in one emibiliary system, and subsequently the insertion of the second SEMS into the other emibiliary system via the central open mesh of the first SEMS [ 36 ]. The SBS method provides the parallel insertion of two SEMS in the two emibiliary systems [ 33 ].…”

Section: Jaundice and Cholangitismentioning

confidence: 99%

“…The SBS method provides the parallel insertion of two SEMS in the two emibiliary systems [ 33 ]. The SBS method is generally preferred over the SIS for the easier deployment technique, and the easier reintervention in case of SEMS misfunction [ 36 ]. The studies comparing the two techniques are sparse, and there is no evidence demonstrating the superiority of one of the two techniques.…”

Section: Jaundice and Cholangitismentioning

confidence: 99%

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Palliation in Gallbladder Cancer: The Role of Gastrointestinal Endoscopy

Schepis

Boškoski

Tringali

et al. 2022

Cancers

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Gallbladder cancer is a rare malignancy burdened by poor prognosis with an estimated 5-year survival of 5% to 13% due to late presentation, early infiltration of surrounding tissues, and lack of successful treatments. The only curative approach is surgery; however, more than 50% of cases are unresectable at the time of diagnosis. Endoscopy represents, together with surgery and chemotherapy, an available palliative option in advanced gallbladder cancers not eligible for curative treatments. Cholangitis, jaundice, gastric outlet obstruction, and pain are common complications of advanced gallbladder cancer that may need endoscopic management in order to improve the overall survival and the patients’ quality of life. Endoscopic biliary drainage is frequently performed to manage cholangitis and jaundice. ERCP is generally the preferred technique allowing the placement of a plastic stent or a self-expandable metal stent depending on the singular clinical case. EUS-guided biliary drainage is an available alternative for patients not amenable to ERCP drainage (e.g., altered anatomy). Gastric outlet obstruction is another rare complication of gallbladder malignancy growing in contact with the duodenal wall and causing its compression. Endoscopy is a less invasive alternative to surgery, offering different options such as an intraluminal self-expandable metal stent or EUS-guided gastroenteroanastomosis. Abdominal pain associated with cancer progression is generally managed with medical treatments; however, for incoercible pain, EUS-guided celiac plexus neurolysis has been described as an effective and safe treatment. Locoregional treatments, such as radiofrequency ablation (RFA), photodynamic therapy (PDT), and intraluminal brachytherapy (IBT), have been described in the control of disease progression; however, their role in daily clinical practice has not been established yet. The aim of this study is to perform a review of the literature in order to assess the role of endoscopy and the available techniques in the palliative therapy of advanced gallbladder malignancy.

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