ASGE Postgraduate Course at ACG: Innovative Practices for the Endoscopist of Today, Tomorrow and Beyond | October 2023-5

5_ASGE postgrad hilar obstruction

Pdf Summary

The document is a summary of a presentation from the ASGE Postgraduate Course focused on the endoscopic management of hilar obstruction, delivered by Drs. Joanna Law, Swati Pawa, and Andrew Storm on October 22, 2023.<br /><br />### Key Topics:<br />1. **Hilar Obstruction Management:**<br />   - Assess anatomy and choose an approach for hilar obstruction.<br />   - Review ASGE guidelines on whether to use endoscopic or percutaneous drainage, the number of liver segments to drain, and the ideal type of stent.<br /><br />2. **Malignant Hilar Obstruction:**<br />   - Differentiates intrinsic vs. extrinsic obstruction.<br />   - Emphasizes a low 5-year survival rate (10%) and non-resectability (70%).<br /><br />3. **Diagnostics and Imaging:**<br />   - Criteria for diagnosing hilar cholangiocarcinoma.<br />   - Goals of imaging to identify masses, stage the disease, and plan drainage.<br /><br />4. **Bismuth Corlette Classification:**<br />   - Classification assists in deciding between endoscopic procedures and surgery.<br /><br />5. **Case Studies and Guidelines:**<br />   - **Case #1:** Discusses a 72-year-old man with malignant hilar obstruction, highlighting ASGE’s recommendations against routine use of PTBD.<br />   - **Case #2:** Evaluates stent choices in a 58-year-old with metastatic gastric cancer, favoring metal stents for poor prognosis and plastic stents when the strategy is unclear.<br />   - **Case #3:** Addresses complications and outcomes when traditional stents fail in a 68-year-old with unresectable cholangiocarcinoma.<br />   - **Case #4:** Highlights the use of radiofrequency ablation (RFA) in endoscopic treatments.<br /><br />### Emerging Techniques:<br />- **Radiofrequency Ablation (RFA):**<br />  - Explained with technical details and its role in improving stent patency and survival with fewer side effects compared to PDT.<br />  - Describes the procedure, equipment, and potential adverse events.<br /><br />### Summary Guidelines:<br />- Review and assess liver volumes through cross-sectional imaging.<br />- Discuss cases in multidisciplinary teams.<br />- Limit contrast injections and focus drainage on non-atrophic, viable liver segments.<br />- Understand different drainage methods (endoscopic and percutaneous) and the use of adjunct therapies for non-operable strictures.<br /><br />The presentation concludes with a recommendation to continually evaluate and adopt emerging techniques for managing complex cases of hilar obstruction.

Keywords

Hilar Obstruction

Endoscopic Management

ASGE Guidelines

Malignant Hilar Obstruction

Diagnostics

Imaging

Bismuth Corlette Classification

Case Studies

Radiofrequency Ablation

Emerging Techniques