Re-intervention for recurrent biliary obstruction after biliary self-expandable metallic stent deployment: Current status and Up To Date report on treatment strategies

Abstract

Self-expandable metallic stents (SEMS) with longer patency have been recommended for endoscopic drainage of unresectable malignant biliary obstruction. Recently developed chemotherapy regimens have prolonged the survival of patients with malignant pancreatobiliary disease. As a result, we have increasingly encountered patients requiring re-intervention for recurrent biliary obstruction (RBO) due to SEMS dysfunction. These patients are often in poor general condition which can quickly worsen without appropriate interventions. Therefore, such patients require prompt and appropriate therapeutic management. For re-intervention, we should develop a treatment strategy for RBO that considers the primary disease, approach, location and form of SEMS placement, and type of SEMS. The clinical state is often complicated, involving a variety of factors. Hence, a multidisciplinary treatment protocol must be employed, in collaboration with surgeons and radiologists, rather than adhering to endoscopic therapy alone.