ASGE Annual Postgraduate Course Endoscopy 2022: Breakthrough to Excellence | DDW 2022-Irani

Irani_Mx bili obs cut stent or diff route

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This document discusses the management of biliary obstruction and the use of different procedures such as stenting, cutting, and finding an alternative route. The author discloses relevant financial relationships with medical companies. <br /><br />The document presents several scenarios, including a case of an 87-year-old female patient with jaundice and vague abdominal discomfort. The next steps involve assessing the patient's history, conducting a physical examination, and performing lab tests and imaging to determine the appropriate course of action. The importance of cross-sectional imaging, such as CT and MRI/MRCP, is highlighted to identify any masses, abscesses, or other abnormalities. <br /><br />In another scenario, a patient with biliary obstruction and a pancreas mass is discussed. The author suggests a multidisciplinary discussion, a panc protocol/staging CT, and potential EUS and ERCP procedures. The decision to proceed with ERCP is based on factors such as symptomatic obstruction, the need for surgery delay, bilirubin levels, and the patient's surgical candidacy.<br /><br />The document also addresses cases of biliary obstruction without an obvious mass and the potential use of EUS procedures. The author discusses different techniques for biliary drainage, including rendezvous, new anastomosis, and downstream stenting. Tips and considerations for each procedure are provided.<br /><br />Additionally, the document presents comparative studies between EUS and ERCP for biliary drainage, highlighting technical success rates, clinical success rates, and adverse events. The learning curve for EUS-guided biliary drainage is also discussed, with studies showing a reduction in adverse events over time.<br /><br />In conclusion, the document emphasizes the importance of a thorough assessment of patients with biliary obstruction, including history, physical examination, lab tests, and imaging. The use of EUS-guided biliary access/drainage can be effective and safe in expert hands, although the procedure is still challenging and requires a learning curve. Proper preparation for adverse events is crucial for successful management.

Keywords

biliary obstruction

procedures

stenting

patient assessment

imaging

pancreas mass

EUS

ERCP

biliary drainage

adverse events