ASGE Annual Postgraduate Course: Clinical Challenges and Real-Time Decision Making in GI Endoscopy (Live and Virtual) | May 2023-Session 10 Presentation 1

Video Transcription

Video Summary

The video is a presentation on biliary stenting given by an unknown speaker. The speaker begins by emphasizing the importance of proper diagnostics, including knowing the location and indication for biliary stenting. They explain that it is necessary to differentiate between malignant and benign disease and suggest using tissue sampling for diagnosis. The speaker also highlights the significance of knowing the location before performing biliary stenting and recommends proper imaging techniques such as CT scans and MRCT. They stress the importance of being well-prepared for hilar stenting and advise multidisciplinary meetings. The speaker then discusses the indications for biliary stenting, including high bilirubin levels, pruritus, prior to surgery, or as a result of chemotherapeutic treatment. They reference a comprehensive guideline published in January as a valuable resource for biliary stenting. The speaker mentions a study from 2010 on preoperative biliary drainage and complications, indicating that routine drainage may not be necessary. They explain that uncovered metal stents should be placed at least 1.5 centimeters below the hilum to avoid surgical interference. They recommend fully covered stents for benign indications, except when the gallbladder is still present. For perihylar strictures, the speaker advises drainage if the patient experiences symptoms or requires treatment, emphasizing the need for 50% drainage of the liver and consideration of the future remnant liver. They discuss the use of ESCP or PTCD procedures and suggest using plastic stents before considering uncovered metal stents. The speaker concludes by summarizing the key points: proper diagnostics, understanding the location, considering the indication, and using appropriate stents for extra-hepatic and intra-hepatic biliary stenting.

Asset Subtitle

Jeanin E. Van Hooft, MD, FASGE

Keywords

biliary stenting

diagnostics

malignant disease

benign disease

tissue sampling