ASGE Annual Postgraduate Course Endoscopy 2022 (On-Demand): Breakthrough to Excellence-Irani

Irani_Mx bili obs cut stent or diff route
Pdf Summary
The document discusses the management of biliary obstruction, including the use of stents, cutting procedures, and alternative routes. It covers different scenarios and cases, providing guidance on the next steps and considerations in each situation. The document also includes information on the role of various imaging techniques, such as CT and MRI/MRCP, in diagnosing biliary obstruction.<br /><br />In scenario 1, an 87-year-old female patient presents with jaundice and vague abdominal discomfort. The document provides guidance on history, physical examination, lab tests, and imaging. It raises the question of whether additional imaging is necessary based on the patient's symptoms and clinical presentation.<br /><br />Scenario 2 involves a patient with biliary obstruction and an obvious pancreatic mass on imaging. The document suggests discussing the case with a multidisciplinary team and conducting a pancreatic protocol/staging CT. It also mentions the role of EUS (endoscopic ultrasound) and ERCP (endoscopic retrograde cholangiopancreatography) in such cases.<br /><br />Scenario 3 addresses biliary obstruction without an obvious mass, particularly in cases of double duct involvement. The document discusses the indications for ERCP and the factors to consider in deciding whether ERCP is necessary.<br /><br />Scenario 4 involves distal or mid-biliary obstruction that is symptomatic. The document suggests having a conversation with the surgeon about possible interventions, including PTBD (percutaneous transhepatic biliary drainage), rendezvous, and anastomosis. It also mentions EUS biliary drainage as an option in certain scenarios.<br /><br />The document concludes with a comparison of EUS and ERCP for biliary drainage, mentioning studies that have examined the technical and clinical success rates as well as adverse events associated with these procedures. It also discusses the learning curve involved in performing EUS-guided biliary access/drainage and emphasizes the importance of thorough evaluation, preparation for adverse events, and expert management.<br /><br />Overall, the document provides an overview of the management of biliary obstruction and offers guidance on the appropriate interventions based on different scenarios and clinical presentations.
Keywords
biliary obstruction
stents
imaging techniques
MRI/MRCP
jaundice
pancreatic mass
EUS
ERCP
biliary drainage