Year 2024 / Volume 116 / Number 12
Letter
Endoscopic drainage of malignant distal biliary obstruction. Will endoscopic retrograde cholangiopancreatography no longer be necessary?

716-717

DOI: 10.17235/reed.2024.10222/2023

Jesús García-Cano, Miriam Viñuelas Chicano, Laura Valiente González,

Abstract
We read with interest the Editorial from Vila et al. on the paradigm shift for endoscopic biliary drainage of malignant distal biliary obstruction (MDBO) which places Endoscopic Ultrasound (EUS) drainage as the first option instead of traditional ERCP drainage. The modern biliary endoscopist must have the duodenoscope in one hand and the therapeutic echoendoscope in the other. ERCP training alone is no longer appropriate because the goal is to drain the obstruction during a single session. That is why in more and more centers the patient signs a single consent for endoscopic biliary drainage, whether by ERCP, EUS or combined. Should EUS drainage be used first for MDBO without attempting ERCP? A possible protocol for endoscopic drainage of MDBO could be to start with the duodenoscope for ERCP. If the papilla of Vater is accessible, try cannulation considering the ESGE criteria for a difficult cannulation: more than 5 contacts with the papilla; more than 5 minutes spent attempting to cannulate following visualization of the papilla; more than one unintended pancreatic duct cannulation or opacification. If biliary cannulation is not achieved, immediately switch to EUS drainage during the same session. Occasionally, the double guidewire technique or even transpancreatic biliary sphincterotomy could be used, but not needle-knife precut.
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References
1.Vila JJ, Jusué Irurita V, Rullán Iriarte M. Is ERCP still the elective primary biliary drainage technique in patients with malignant distal biliary obstruction? Rev Esp Enferm Dig. 2023. doi: 10.17235/reed.2023.10029/2023. Epub ahead of print. PMID: 38095214.
2.García-Cano J, Alburquerque M, Pérez Roldán F, et al. Psychological impact of a failed ERCP on the endoscopist. Gastrointest Endosc 2020;91(5S):AB284. DOI: 10.1016/j.gie.2020.03.1900.
3.Spadaccini M, Binda C, Fugazza A, et al, On Behalf Of The Interventional Endoscopy Amp Ultra Sound I-EUS Group. Informed Consent for Endoscopic Biliary Drainage: Time for a New Paradigm. Medicina (Kaunas). 2022; 58: 331. doi: 10.3390/medicina58030331. PMID: 35334507.
4 .Vanella G, Dell'Anna G, van Wanrooij RLJ, et al. Managing dysfunctions and reinterventions in endoscopic ultrasound-guided choledochoduodenostomy with lumen apposing metal stents: Illustrated technical review (with videos). Dig Endosc. 2023; doi: 10.1111/den.14708. Epub ahead of print. PMID: 37852797.
5.Testoni PA, Mariani A, Aabakken L, et al. Papillary cannulation and sphincterotomy techniques at ERCP: European Society of Gastrointestinal Endoscopy (ESGE) Clinical Guideline. Endoscopy 2016 ; 657 83. doi:10.1055/s 0042 108641. PMID: 27299638.
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García-Cano J, Viñuelas Chicano M, Valiente González L. Endoscopic drainage of malignant distal biliary obstruction. Will endoscopic retrograde cholangiopancreatography no longer be necessary?. 10222/2023


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Publication history

Received: 28/12/2023

Accepted: 11/01/2024

Online First: 23/01/2024

Published: 13/12/2024

Article Online First time: 26 days

Article editing time: 351 days


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