Postgraduate Course at DDW: Complete Clinical Updates for Today's Practice

14_Sunday_SIDDIQUI.3VIDEOS

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The document provides an overview of endoscopic techniques used to treat obstructive jaundice, focusing on various scenarios such as benign and malignant biliary obstructions. Dr. Uzma D. Siddiqui from the University of Chicago outlines critical procedures employed in endoscopic treatment, including Endoscopic Retrograde Cholangiopancreatography (ERCP), Endoscopic Ultrasound (EUS), and EUS-guided biliary access. <br /><br />The document categorizes biliary obstruction into malignant causes, such as cholangiocarcinoma and pancreatic cancer, and benign causes, like choledocholithiasis and post-surgical strictures. Emphasis is placed on the evaluation and management of distal and hilar obstructions, with case studies illustrating treatment pathways.<br /><br />For benign distal obstructions, a case highlights a middle-aged male with chronic pancreatitis but no detectable malignancy, treated with a Fully Covered Self Expandable Metal Stent (FCSEMS). The efficacy of this approach is comparable to alternatives but with fewer ERCPs.<br /><br />In cases of malignant hilar obstruction, considerations include cross-sectional imaging, oncologic planning, and the careful selection of stenting strategy, stressing a preference for plastic stents with routine exchange over metal stents unless circumstances dictate otherwise.<br /><br />Challenges in altered surgical anatomy, such as those arising from procedures like Whipple resection or Roux-en-Y hepaticojejunostomy, are addressed with specialized scopes and techniques. This includes device-assisted enteroscopy tools for navigating altered anatomy.<br /><br />EUS-guided techniques are particularly crucial for biliary access and drainage, providing options like transpapillary and transmural methods. These are vital when ERCP is not feasible, especially in complex scenarios, such as failed bile duct drainage in malignant biliary obstruction.<br /><br />The document concludes with key takeaways about the central role of ERCP and EUS in managing biliary obstruction, stressing the importance of multi-disciplinary discussions and the adaptation of strategies based on the obstruction's etiology, location, and patient anatomy.

Keywords

endoscopic techniques

obstructive jaundice

biliary obstructions

ERCP

EUS

biliary access

malignant obstruction

benign obstruction

stenting strategy

altered surgical anatomy