Endoscopic Drainage and Ablative Options for Pancreatobiliary Tumors

Endoscopic Drainage and Ablative Options for Pancreatobiliary Tumors

  • Endoscopic biliary drainage with a self-expandable metal stent (SEMS) is the standard of care today.
  • More than 50% of liver volume must be drained to effectively palliate and avoid atrophic lobe drainage in multifocal hepatic steatosis (MHS).
  • Two or more uncovered SEMS are preferred in high-grade hilar tumors. It is important to prevent contamination of segments that have not been drained.
  • EUS-guided choledochoduodenostomy (EUSBD) is preferred if endoscopic retrograde cholangiopancreatography (ERCP) drainage fails or is incomplete.
  • Percutaneous transhepatic biliary drainage (PTBD) is a valid option if ERCP fails or in altered anatomy. It is associated with a high success rate (87-100%).
  • Intraductal photodynamic therapy (PDT) and possibly endobiliary radiofrequency ablation (eRFA) improve survival.
  • Asia Pacific Consensus 2013 advises SEMS for palliation of high-grade MHS if the expected survival of the patient is more than 3 months.
  • ESGE Guidelines 2018 recommends uncovered SEMS as a choice of the stent in MHS for palliative drainage.
  • ERCP is the first choice for lower-end and Bismuth I and II. However, there is controversy in the route of drainage (ERCP or PTBD) of the advanced MHS.

Dr. Randhir Sud

The Chairman of the Department of Digestive & Hepatobiliary Sciences, Medanta The Medicity, Gurgaon. Dr Randhir Sud is an eminent doctor of Gastroenterology. He has been working to establish the therapeutic GI Endoscopy in India. He started the GI Oncology program in India. Randhir Sud pursued the M.B.B.S degree from the Government Medical College in Amritsar in 1977, M.D. (Medicine) in 1981 at AIIMS, New Delhi, where he also attained the D.M. (Gastroenterology) degree in 1983. n 2008, he bagged the Padmashri Award for his contribution in Gastroenterology. His expertise lies in Gastro Intestinal Endoscopy, Gastro Intestinal Cancers, and Hepatic diseases.


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