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

doi:10.1055/a-0659-9864

Endoscopy, Table of Contents

Endoscopy 2018; 50(09): 910-930
DOI: 10.1055/a-0659-9864

Guideline

Endoscopic biliary stenting: indications, choice of stents, and results: European Society of Gastrointestinal Endoscopy (ESGE) Clinical Guideline – Updated October 2017

Authors

Jean-Marc Dumonceau

¹Gedyt Endoscopy Center, Buenos Aires, Argentina
Andrea Tringali

²Digestive Endoscopy Unit, Catholic University, Rome, Italy
Ioannis S. Papanikolaou

³Hepatogastroenterology Unit, Second Department of Internal Medicine – Propaedeutic, Research Institute and Diabetes Center, Medical School, National and Kapodistrian University, Attikon University General Hospital, Athens, Greece
Daniel Blero

⁴CHU Charleroi et Vésale, ISPPC, Charleroi, Belgium
Benedetto Mangiavillano

⁵Gastrointestinal Endoscopy Unit, Humanitas Mater Domini, Castellanza, Italy - Humanitas University, Milan, Italy
Arthur Schmidt

⁶Department of Gastroenterology, Klinikum Ludwigsburg, University of Heidelberg, Germany
Geoffroy Vanbiervliet

⁷Department of Gastroenterology and Endoscopy, Hôpital Universitaire l’Archet, Nice, France
Guido Costamagna

⁸Digestive Endoscopy Unit Catholic University, Rome, Italy
Jacques Devière

⁹Department of Gastroenterology Hepatopancreatology, and Digestive Oncology, Erasme University Hospital, Université Libre de Bruxelles, Brussels, Belgium
Jesús García-Cano

¹⁰Department of Digestive Diseases, Hospital Virgen de La Luz, Cuenca, Spain
Tibor Gyökeres

¹¹Department of Gastroenterology, Medical Center, Hungarian Defense Forces, Budapest, Hungary
Cesare Hassan

¹²Digestive Endoscopy Unit, Catholic University, Rome, Italy
Frédéric Prat

¹³Gastroenterology Unit, Hôpital Cochin (AP-HP), Paris, France
Peter D. Siersema

¹⁴Department of Gastroenterology and Hepatology, Radboud University Medical Center, Nijmegen, The Netherlands
Jeanin E. van Hooft

¹⁵Department of Gastroenterology and Hepatology, Amsterdam UMC, University of Amsterdam, The Netherlands

Abstract

Main Recommendations

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.

Full Text

References

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