Role of therapeutic endoscopic ultrasound in gastrointestinal malignancy- current evidence and future directions

Endoscopic palliation of malignant biliary obstruction

“…Its role in hilar obstruction is reserved for specific cases as drainage from the left intrahepatic duct does not equate to drainage of a right sided obstruction[ 69 ]. A study described access from the proximal duodenum to right intrahepatic duct (hepaticoduodenostomy) for cases of isolated right sided obstruction (with a technical success 100% and clinical success 83%)[ 82 ], but widespread use of this technique has not been adopted due to difficulty with scope positioning and proper identification of the duct[ 83 ].…”

“…Another large international study of 182 patients (95 HGS, 87 CDS) suggested that CDS was associated with being 4.5 times more likely to achieve longer stent patency at the expense of higher adverse events, which may influence decisions based on patients survival[ 86 ]. In light of advancements with oncologic care, the prospect of reduced long reintervention may steer one to use CDS, especially since reintervention is easier due to shorter stent size, cannulation and steering in the duodenum[ 83 ].…”