Endoscopic palliation of malignant biliary obstruction

Canakis, Andrew; Kahaleh, Michel

doi:10.4253/wjge.v14.i10.581

Cited by 8 publications

(8 citation statements)

References 144 publications

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“…Searching for less invasive and cost-effective approaches for bile duct decompression, stent placement either endoscopically or percutaneously has proven to be effective for the treatment of MBO. At present, endoscopic biliary decompression and drainage remains the preferred modality for patients with amenable disease [3]. However, despite being a first-line treatment strategy, stent occlusion of biliary stents may occur due to biliary sludge accumulation, stent migration, or tumor ingrowth [4].…”

Section: Introductionmentioning

confidence: 99%

Intraductal radiofrequency ablation plus biliary stent versus stent alone for malignant biliary obstruction: a systematic review and meta-analysis

de Oliveira Veras,

de Moura,

McCarty

et al. 2023

Endosc Int Open

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Background and study aims: Recurrent biliary stent occlusion and tumor ingrowth remain a major concern among patients with malignant biliary obstruction (MBO) with significant impact on patient morbidity and survival. Intraductal radiofrequency ablation (RFA) has emerged as a promising treatment that seeks to extend stent patency. This study aimed to evaluate the impact of RFA on overall survival (OS) and stent patency among patients with unresectable MBO. Methods: A comprehensive search of electronic databases was performed for randomized controlled trials (RCTs) comparing RFA plus biliary stent (RFA+S) versus biliary stent alone (S-alone). Outcomes assessed included overall survival, stent patency, and adverse events (AEs) with mean difference (MD) calculated from pooled proportions. Subgroup analyses were performed for hilar strictures and cholangiocarcinoma (CCA). Results: Six RCTs (n = 439 patients) were included and demonstrated improved survival among patients who received RFA+S (MD 85.80 days; 95% confidence interval [CI] 35.02-136.58; I2 = 97%; P < 0.0009). The pooled MD for total stent patency was 22.25 days (95% CI 17.38- 61.87; I2 = 97%; P = 0.27). There was no difference in AEs between RFA+S vs S-alone (P > 0.05). On subgroup analyses, RFA+S was associated with improved stent patency (MD 76.73 days; 95% CI 50.11-103.34; I2 = 67%; P <0.01) and OS (MD 83.14 (95% CI 29.52-136.77; I2 = 97%; P < 0.01] for CCA. For hilar strictures, stent patency was improved among patients with RFA+S [MD 83.71 days (95% CI 24.85-142.56; I2 = 84%; P < 0.01]. Conclusions: RFA+S improved OS in the treatment of MBO when compared with S-alone. Moreover, the RFA therapy prolonged stent patency in hilar strictures and CCA, with similar rates of AEs.

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Section: Introductionmentioning

confidence: 99%

Intraductal radiofrequency ablation plus biliary stent versus stent alone for malignant biliary obstruction: a systematic review and meta-analysis

de Oliveira Veras,

de Moura,

McCarty

et al. 2023

Endosc Int Open

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“…ERCP is performed with a duodenoscope that permits the wire-guided cannulation of the ampulla of Vater and then biliary drainage and bile collection in patients with an obstruction of the bile duct [52,53]. A catheter and a syringe can be used to collect bile, but also other devices [54] have been developed helping to collect tissue and cell samples in addition to bile aspiration.…”

Section: Transpapillary Ercpmentioning

confidence: 99%

Bile as a liquid biopsy matrix: potential applications and limitations

Arechederra,

Rullán,

Oyón

et al. 2024

Explor Dig Dis

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Hunting for tumoral material in body fluids, traditionally in blood, the so-called liquid biopsy is set to revolutionize the diagnosis and management of oncological patients. However, other biofluids can also be considered as alternative sources of biomarkers to provide clinically valuable information for multiple diseases. This is the case of bile, a fluid produced in the liver, stored in the gallbladder, and excreted to the duodenum, which complex composition is known to change in different pathological conditions. Remarkably, different works have demonstrated that the identification of mutations in bile cell-free DNA (cfDNA) can outperform blood analysis for the early diagnosis of biliopancreatic tumors causing biliary strictures. Here, the literature in which bile has been tested as a liquid biopsy matrix where lipids, metabolites, proteins, and cfDNA among other analytes were measured is reviewed. Moreover, the clinical situations and procedures where bile can be available, discussing the possible applications and limitations of bile analysis are summarized. The scientific relevance and clinical potential of bile harvesting, biobanking, and analysis are put forward. All this evidence supports the value of bile as a liquid biopsy matrix for the management of patients beyond cancer, and perhaps also beyond “blood, sweat, and tears”.

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“…The most common etiologies of DMBO are pancreatic head adenocarcinoma and extrahepatic cholangiocarcinoma. Other reasons are gallbladder cancer, ampullary cancer, lymphoma, and malignant metastases [ 1 - 3 ]. Hilar cholangiocarcinoma, also known as a Klatskin tumor, is the main reason for HMBO, followed by gallbladder cancers, hepatocellular carcinomas, lymphomas, and metastatic malignancies [ 4 - 6 ].…”

Section: Introductionmentioning

confidence: 99%

Endoscopic management of malignant biliary obstructions

Binda

2024

aog

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Malignant biliary obstruction (MBO), both distal and hilar, represents an ensemble of different clinical conditions frequently encountered in everyday practice. Given the frequent unresectability of the disease at presentation and the increasing indications for neoadjuvant chemotherapy, endoscopic biliary drainage is generally required during the course of the disease. With the widespread use of interventional endoscopic ultrasound (EUS) and the introduction of dedicated devices, EUS-guided biliary drainage has rapidly gained acceptance, together with transpapillary endoscopic biliary drainage and the percutaneous approach. This comprehensive review describes the current role of endoscopy for distal and hilar MBO supported by evidence, with a focus on the current hot topics in this field.

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Endoscopic palliation of malignant biliary obstruction

Cited by 8 publications

References 144 publications

Intraductal radiofrequency ablation plus biliary stent versus stent alone for malignant biliary obstruction: a systematic review and meta-analysis

Intraductal radiofrequency ablation plus biliary stent versus stent alone for malignant biliary obstruction: a systematic review and meta-analysis

Bile as a liquid biopsy matrix: potential applications and limitations

Endoscopic management of malignant biliary obstructions

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