Endoscopic biliary stenting: indications, choice of stents, and results: European Society of Gastrointestinal Endoscopy (ESGE) Clinical Guideline - Updated October 2017
Jean-Marc Dumonceau, Andrea Tringali, Ioannis S Papanikolaou, Daniel Blero, Benedetto Mangiavillano, Arthur Schmidt, Geoffroy Vanbiervliet, Guido Costamagna, Jacques Devière, Jesús García-Cano, Tibor Gyökeres, Cesare Hassan, Frédéric Prat, Peter D Siersema, Jeanin E van Hooft, Jean-Marc Dumonceau, Andrea Tringali, Ioannis S Papanikolaou, Daniel Blero, Benedetto Mangiavillano, Arthur Schmidt, Geoffroy Vanbiervliet, Guido Costamagna, Jacques Devière, Jesús García-Cano, Tibor Gyökeres, Cesare Hassan, Frédéric Prat, Peter D Siersema, Jeanin E van Hooft
Abstract
ESGE recommends against routine preoperative biliary drainage in patients with malignant extrahepatic biliary obstruction; preoperative biliary drainage should be reserved for patients with cholangitis, severe symptomatic jaundice (e. g., intense pruritus), or delayed surgery, or for before neoadjuvant chemotherapy in jaundiced patients. Strong recommendation, moderate quality evidence. ESGE recommends the endoscopic placement of a 10-mm diameter self-expandable metal stent (SEMS) for preoperative biliary drainage of malignant extrahepatic biliary obstruction. Strong recommendation, moderate quality evidence.ESGE recommends SEMS insertion for palliative drainage of of extrahepatic malignant biliary obstruction. Strong recommendation, high quality evidence. ESGE recommends against the insertion of uncovered SEMS for the drainage of extrahepatic biliary obstruction of unconfirmed etiology. Strong recommendation, low quality evidence. ESGE suggests against routine preoperative biliary drainage in patients with malignant hilar obstruction. Weak recommendation, low quality evidence.ESGE recommends uncovered SEMSs for palliative drainage of malignant hilar obstruction. Strong recommendation, moderate quality evidence.ESGE recommends temporary insertion of multiple plastic stents or of a fully covered SEMS for treatment of benign biliary strictures. Strong recommendation, moderate quality evidence.ESGE recommends endoscopic placement of plastic stent(s) to treat bile duct leaks that are not due to transection of the common bile duct or common hepatic duct. Strong recommendation, moderate quality evidence.
Conflict of interest statement
G. Costamagna has provided research support to Cook Medical and Taewoong; his department has received research support from Boston Scientific. J. Devière’s department has received research support for institutional review board-approved studies, from Olympus (ongoing), Boston Scientific (ongoing), and Cook Medical (from 2015 to 2016). F. Prat has provided consultancy to Olympus (2016 to 2018, continuing) and Boston Scientific (2015 to 2018, continuing). P.D. Siersema has provided research support to Ella-CS (from June 2016 to present). J. van Hooft has received lecture fees from Medtronic (from 2014 to 2015) and consultancy fees from Boston Scientific (from 2014 to 2016); her department has received research grants from Cook Medical (from 2014 to 2017) and Abbott (from 2014 to 2017). G. Vanbiervliet has provided consultancy to Boston Scientific (from 2016 to present). D. Blero, J.-M. Dumonceau, J. García-Cano, T. Gyökeres, C. Hassan, B. Mangiavillano, I.S. Papanikolaou, A. Schmidt, and A. Tringali have no competing interests.
© Georg Thieme Verlag KG Stuttgart · New York.
Source: PubMed