ASGE guideline on the role of endoscopy in the management of malignant hilar obstruction

Bashar J. Qumseya, Laith H. Jamil, Badih Joseph Elmunzer, Ahsun Riaz, Eugene P. Ceppa, Nirav C. Thosani, James L. Buxbaum, Andrew C. Storm, Mandeep S. Sawhney, Swati Pawa, Mariam Naveed, Jeffrey K. Lee, Joanna K. Law, Richard S. Kwon, Terry L. Jue, Larissa L. Fujii-Lau, Douglas S. Fishman, Audrey H. Calderwood, Stuart K. Amateau, Mohammed Al-HaddadSachin Wani

Research output: Contribution to journalArticlepeer-review

Abstract

This clinical guideline from the American Society for Gastrointestinal Endoscopy (ASGE) provides an evidence-based approach for the management of patients with malignant hilar obstruction (MHO). This document was developed using the Grading of Recommendations Assessment, Development and Evaluation framework and addresses primary drainage modality (percutaneous transhepatic biliary drainage [PTBD] vs endoscopic biliary drainage [EBD]), drainage strategy (unilateral vs bilateral), and stent selection (plastic stent [PS] vs self-expandable metal stent [SEMS]). Regarding drainage modality, in patients with MHO undergoing drainage before potential resection or transplantation, the panel suggests against routine use of PTBD as first-line therapy compared with EBD. In patients with unresectable MHO undergoing palliative drainage, the panel suggests PTBD or EBD. The final decision should be based on patient preferences, disease characteristics, and local expertise. Regarding drainage strategy, in patients with unresectable MHO undergoing palliative stent placement, the panel suggests placement of bilateral stents compared with a unilateral stent in the absence of liver atrophy. Finally, regarding type of stent, in patients with unresectable MHO undergoing palliative stent placement, the panel suggests placing SEMSs or PSs. However, in patients who have a short life expectancy and who place high value on avoiding repeated interventions, the panel suggests using SEMSs compared with PSs. If optimal drainage strategy has not been established, the panel suggests placing PSs. This document clearly outlines the process, analyses, and decision processes used to reach the final recommendations and represents the official ASGE recommendations on the above topics.

Original languageEnglish (US)
Pages (from-to)222-234.e22
JournalGastrointestinal endoscopy
Volume94
Issue number2
DOIs
StatePublished - Aug 1 2021

Bibliographical note

Funding Information:
This guideline was funded exclusively by the American Society for Gastrointestinal Endoscopy; no outside funding was received to support the development of this guideline.

Funding Information:
The authors are grateful to Patricia Maxin from the Cholangiocarcinoma Foundation for her input as a patient advocate on this guideline panel.

Funding Information:
The following authors disclosed financial relationships: B. Qumseya disclosed no financial relationships. L. Jamil disclosed no financial relationships. B. Elmunzer is a consultant for Takeda Pharmaceuticals. A. Riaz disclosed no financial relationships. E. Ceppa disclosed no financial relationships. N. Thosani is a consultant for Boston Scientific Coporation, TaeWoong Medical; is a consultant and receives research support from PENTAX of America, Inc,; receives royalties from UpToDate; receives research support from Endogastric Solutions; is a speaker for Abbie; and is on the advisory board for ColubrisMX Inc. J. Buxbaum is a consultant for Boston Scientific Corporation, Eagle Pharmaceuticals, Inc, Cook Medical LLC, and Olympus America Inc; and receives grant support from Medtronic USA, Inc and Olympus America Inc. A. Storm is a consultant for Apollo Endo Surgery, Endo-TAGSS, and Enterasense; data and safety monitoring from ERBE USA Inc and GI Dynamics; and receives research support from Boston Scientific. M. Sawhney is a stock holder with Allurion Technology, Inc. S. Pawa disclosed no financial relationships. M. Naveed disclosed no financial relationships. J. Lee disclosed no financial relationships. J. Law disclosed no financial relationships. R. Kwon disclosed no financial relationships. T. Jue disclosed no financial relationships. L. Fujii-Lau has received travel compensation from Ovesco. D. Fishman disclosed no financial relationships. A. Calderwood disclosed no financial relationships. S. Amateau is a consultant for Boston Scientific Corporation, Cook Medical LLC, Endo-Therapeutics, Hemostasis LLC, Merit Medical Systems Inc, Olympus Corporation of the Americas, and STERIS Corporation. M. Al-Haddad has received research and teaching support from Boston Scientific Corporation. S. Wani is a consultant for Boston Scientific Corporation, Medtronic, Exact Sciences and Interpace; and is on the advisory board for Cernostics.

Publisher Copyright:
© 2021 American Society for Gastrointestinal Endoscopy

PubMed: MeSH publication types

  • Practice Guideline

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