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2024 ; 16
(7
): 1981-1985
Nephropedia Template TP
gab.com Text
Twit Text FOAVip
Twit Text #
English Wikipedia
Role of endoscopic-ultrasound-guided biliary drainage with
electrocautery-enhanced lumen-apposing metal stent for palliation of malignant
biliary obstruction
#MMPMID39087127
Deliwala SS
; Qayed E
World J Gastrointest Surg
2024[Jul]; 16
(7
): 1981-1985
PMID39087127
show ga
In this editorial, we discuss the article by Peng et al in the recent issue of
the World Journal of Gastrointestinal Surgery, focusing on the evolving role of
endoscopic-ultrasound-guided biliary drainage (EUS-BD) with electrocautery lumen
apposing metal stent (LAMS) for distal malignant biliary obstruction. Therapeutic
endoscopy has rapidly advanced in decompression techniques, with growing evidence
of its safety and efficacy surpassing percutaneous and surgical approaches. While
endoscopic retrograde cholangiopancreatography (ERCP) has been the gold standard
for biliary decompression, its failure rate approaches 10.0%, prompting the
exploration of alternatives like EUS-BD. This random-effects meta-analysis
demonstrated high technical and clinical success of over 90.0% and an adverse
event rate of 17.5%, mainly in the form of stent dysfunction. Outcomes based on
stent size were not reported but the majority used 6 mm and 8 mm stents. As the
body of literature continues to demonstrate the effectiveness of this technique,
the challenges of stent dysfunction need to be addressed in future studies. One
strategy that has shown promise is placement of double-pigtail stents, only 18%
received the prophylactic intervention in this study. We expect this to improve
with time as the technique continues to be refined and standardized. The results
above establish EUS-BD with LAMS as a reliable alternative after failed ERCP and
considering EUS to ERCP upfront in the same session is an effective strategy.
Given the promising results, studies must explore the role of EUS-BD as
first-line therapy for biliary decompression.