Should stents be changed prophylactically in malignant obstructive jaundice? computer modeling to optimize the use of health care resources

International consensus statements for endoscopic management of distal biliary stricture

“…Monitoring strategies to detect early RBO have not been well studied and are mostly based on empiric evidence and extrapolation from the published literature. Furthermore, the management approach is dependent on local resources (availability and cost of laboratory and imaging evaluations) and patient factors (distance a patient has to travel for follow‐up visits) . Possible monitoring options include outpatient clinic visits with evaluation of liver chemistry, with or without supplemental periodic remote monitoring of liver chemistry.…”

“…Furthermore, the management approach is dependent on local resources (availability and cost of laboratory and imaging evaluations) and patient factors (distance a patient has to travel for follow-up visits). 38 Possible monitoring options include outpatient clinic visits with evaluation of liver chemistry, with or without supplemental periodic remote monitoring of liver chemistry. When physical examination or liver chemistry suggests possible stent dysfunction, transabdominal ultrasound and/or plain abdominal film can be performed to assess stent position and to evaluate for the presence or absence of pneumobilia.…”