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Endoscopic Reintervention for Recurrence of Malignant Biliary Obstruction: Developing the Best Strategy

Kudo Masatoshi|Takenaka Mamoru
거트앤리버 소화기연관학회협의회|2022.07|Gut and Liver|제16권 제4호|pp. 525-534|DOI 10.5009/gnl210228

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참고문헌

키워드

StentInterventional ultrasonographyJaundiceobstructive

초록

Drainage therapy for malignant biliary obstruction (MBO) includes trans-papillary endoscopic retrograde biliary drainage (ERBD), percutaneous transhepatic biliary drainage (PTBD), and transgastrointestinal endoscopic ultrasound-guided biliary drainage (EUS-BD). With the development of chemotherapy, many MBO cases end up needing endoscopic reintervention (E-RI) for recurrent biliary obstruction. To achieve a successful E-RI, it is necessary to understand the various findings regarding E-RI in MBO cases reported to date. Therefore, in this review, we focus on E-RI for ERBD of distal MBO, ERBD of hilar MBO, and EUS-BD. To plan an appropriate E-RI strategy for biliary stent occlusion for MBO, the following must be considered on a case-by-case basis: the urgency of the drainage, the cause of the occlusion, the original route of drainage (PTBD/ERBD/EUS-BD), the initial stent used (plastic stent or self-expandable metallic stent), and in the case of self-expandable metallic stents, the type used (fully covered or uncovered). Regardless of the original method of stent placement, if the inflammation caused by obstructive cholangitis is severe and/or the patient is in shock, PTBD should be considered as the first choice. Finally, it is important to keep in mind that in many cases, performing E-RI will be difficult.

Abstract

Drainage therapy for malignant biliary obstruction (MBO) includes trans-papillary endoscopic retrograde biliary drainage (ERBD), percutaneous transhepatic biliary drainage (PTBD), and transgastrointestinal endoscopic ultrasound-guided biliary drainage (EUS-BD). With the development of chemotherapy, many MBO cases end up needing endoscopic reintervention (E-RI) for recurrent biliary obstruction. To achieve a successful E-RI, it is necessary to understand the various findings regarding E-RI in MBO cases reported to date. Therefore, in this review, we focus on E-RI for ERBD of distal MBO, ERBD of hilar MBO, and EUS-BD. To plan an appropriate E-RI strategy for biliary stent occlusion for MBO, the following must be considered on a case-by-case basis: the urgency of the drainage, the cause of the occlusion, the original route of drainage (PTBD/ERBD/EUS-BD), the initial stent used (plastic stent or self-expandable metallic stent), and in the case of self-expandable metallic stents, the type used (fully covered or uncovered). Regardless of the original method of stent placement, if the inflammation caused by obstructive cholangitis is severe and/or the patient is in shock, PTBD should be considered as the first choice. Finally, it is important to keep in mind that in many cases, performing E-RI will be difficult.

참고문헌 (65)

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관련 논문AI추천

Endoscopic Ultrasound-Guided Biliary Drainage for Unresectable Hilar Malignant Biliary ObstructionHirofumi Kogure, Hiroyuki Isayama, Kazuhiko Koike, Yousuke Nakai대한소화기내시경학회 · Clinical Endoscopy2019 · 제52권 제3호Optimal endoscopic drainage strategy for unresectable malignant hilar biliary obstructionItaru Naitoh, Tadahisa Inoue대한소화기내시경학회 · Clinical Endoscopy2023 · 제56권 제2호Endoscopic ultrasound-guided biliary drainage in malignant hilar obstructionSe Woo Park소화기인터벤션의학회 · International Journal of Gastrointestinal Intervention2022 · 제11권 제3호Proper management of inoperable malignant hilar biliary obstruction: Endoscopic retrograde cholangiopancreatography, endoscopic ultrasound, or percutaneous approach?이태훈소화기인터벤션의학회 · International Journal of Gastrointestinal Intervention2021 · 제10권 제3호Endoscopic biliary drainage for distal bile duct obstruction due to pancreatic cancerMasahiro Itonaga, Masayuki Kitano대한소화기내시경학회 · Clinical Endoscopy2025 · 제58권 제1호Efficacy of endoscopic ultrasound-guided biliary drainage of malignant biliary obstruction: a systematic review and meta-analysis of randomized controlled trialsFabeeha Shaheen, Hafsa Azam, Laila Manzoor, Muaaz Masood, Muhammad Abdullah Bin Azhar, Rajesh Krishnamoorthi, Syed Sarmad Javaid, Yousaf Zafar대한소화기내시경학회 · Clinical Endoscopy2025 · 제58권 제4호

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