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

Abstract

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.

Antireflux covered metal stent for nonresectable distal malignant biliary obstruction: Multicenter randomized controlled trial

“…Endoscopic placement of a self‐expandable metal stent (SEMS) has been first‐line palliative treatment of nonresectable distal malignant biliary obstruction (MBO) because of longer duration of patency compared to plastic stents . Covered SEMS have emerged as an alternative to uncovered SEMS with the expectation of further prolonged patency through preventing tumor tissue and reactive epithelial hyperplasia from invading through the mesh wall .…”

Intraductal placement of non‐flared fully covered metallic stent for refractory anastomotic biliary strictures after living donor liver transplantation: Long‐term results of prospective multicenter trial

“…Third, our stenting period was 3–4 months that was shorter than that in other previous studies. The ideal duration of FCSEMS in benign stricture is not well known and still on debate . Before this study, we conducted pilot study comparing the efficacy and safety of 6‐month stenting versus 3‐month stenting .…”

Benign Biliary Strictures: A Systematic Review on Endoscopic Treatment Options

“…However, limitations include a higher risk of migration. The European Society of Gastroenterology Endoscopy (ESGE) guidelines reinforce that multiple plastic stents (MPSs) and SEMSs are the standard of care currently for the treatment of BBSs (strong recommendation, moderate-quality evidence) [5]. Newer fully covered and intraductal SEMSs have antimigration properties to reduce the risk of stent migration [6].…”