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

• Published in: Gut and liver Vol. 16; no. 4; pp. 525 - 534
• Main Authors: Mamoru Takenaka, Masatoshi Kudo
• Format: Journal Article
• Language: Korean
• Published: 대한소화기기능성질환·운동학회 30.07.2022
• Subjects: Interventional ultrasonography; Jaundice; obstructive; Stent
• ISSN: 1976-2283; 2005-1212

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. (Gut Liver 2022;16:525-534)