Endoscopic transpapillary biliary drainage for malignant biliary obstruction: decipher Japanese, European and American guidelines

Abstract

Nowadays, endoscopic biliary drainage (EBD) is the first choice biliary drainage technique. EBD should be classified on the basis of resectability of tumor and the site of biliary tract obstruction (distal or perihilar bile duct). For resectable cases, Japanese guidelines recommend EBD for distal biliary obstruction. On the other hand, endoscopic nasobiliary drainage was recommend for perihilar biliary obstruction. For unresectable cases, Japanese guidelines recommend self-expandable metallic stent placement. However, unilateral or bilateral biliary drainage and stent-in-stent or side-by-side remains unresolved. We should understand various differences between Japanese and others guidelines. We also should perform biliary drainage based on patient's general condition (age, performance status, underlying disease and severity). In near future, we also should conduct high quality studies regarding biliary drainage for cholangiocarcinoma in the real clinical setting.