Endoscopic preoperative biliary drainage for malignant distal biliary obstruction -up to date-

Abstract

Preoperative biliary drainage (PBD) for malignant distal biliary obstruction is primarily performed via ERCP, and plastic stents (PSs) are recommended in biliary cancer. In pancreatic cancer (PC), routine PBD is not required but is almost mandatory nowadays because neoadjuvant therapy (NAT) for resectable/borderline resectable PC is becoming the standard of care, and self-expandable metal stents (SEMSs) are recommended to complete NAT without delay due to recurrent biliary obstruction (RBO) /cholangitis. However, SEMSs have a high incidence of pancreatitis, which affects the induction of NAT and the rate of surgery, so it is necessary to select and develop a stent that minimizes both RBO/cholangitis and pancreatitis and has minimal impact on surgery. In recent years, endoscopic ultrasound-guided biliary drainage (EUS-BD) is being performed not only in unresectable cases but also in PBD, and the role of EUS-BD in PBD is also an issue for consideration. Large-scale, multidisciplinary, prospective trials are warranted.