Endoscopy International Open (Sep 2024)
The updated Asia-Pacific consensus statement on the role of endoscopic management in malignant hilar biliary obstruction
- Phonthep Angsuwatcharakon,
- Santi Kulpatcharapong,
- Alan Chuncharunee,
- Christopher Khor,
- Benedict Devereaux,
- Jong Ho Moon,
- Thawee Ratanachu-ek,
- Hsiu Po Wang,
- Nonthalee Pausawasdi,
- Amit Maydeo,
- Takao Itoi,
- Ryan Ponnudurai,
- Mohan Ramchandani,
- Yousuke Nakai,
- Dong Wan Seo,
- Takeshi Ogura,
- Raymond SY Tang,
- Pradermchai Kongkam,
- Dadang Makmun,
- Frederick Dy,
- Wiriyaporn Ridtitid,
- Yu Ting Kuo,
- Khanh Cong Pham,
- Borathchakra Oung,
- Jeffrey Lee,
- Rungsun Rerknimitr
Affiliations
- Phonthep Angsuwatcharakon
- ORCiD
- Division of Gastroenterology, Department of Medicine, Faculty of Medicine, Chulalongkorn University and Excellence Center for Gastrointestinal Endoscopy, King Chulalongkorn Memorial Hospital, Bangkok, Thailand
- Santi Kulpatcharapong
- Division of Gastroenterology, Department of Medicine, Faculty of Medicine, Chulalongkorn University and Excellence Center for Gastrointestinal Endoscopy, King Chulalongkorn Memorial Hospital, Bangkok, Thailand
- Alan Chuncharunee
- Division of Gastroenterology and Hepatology, Department of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
- Christopher Khor
- Department of Gastroenterology and Hepatology, Singapore General Hospital, and Duke-NUS Medical School, Singapore, Singapore
- Benedict Devereaux
- Royal Brisbane and Women's Hospital, University of Queensland, Brisbane, Australia
- Jong Ho Moon
- Department of Gastroenterology, SoonChunHyang University School of Medicine, Bucheon, Korea
- Thawee Ratanachu-ek
- Surgery, Rajavithi Hospital, Bangkok, Thailand
- Hsiu Po Wang
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, College of Medicine, National Taiwan University and Hospital, Taipei, Taiwan
- Nonthalee Pausawasdi
- Division of Gastroenterology, Department of Medicine, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
- Amit Maydeo
- ORCiD
- Baldota Institute of Digestive Sciences, Gleneagles Global Hospital, Mumbai, Maharashtra, India
- Takao Itoi
- Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan
- Ryan Ponnudurai
- Department of Gastroenterology, Prince Court Medical Centre, Kuala Lumpur, Malaysia
- Mohan Ramchandani
- Asian Institute of Gastroenterology, Hyderabad, India
- Yousuke Nakai
- ORCiD
- Department of Internal Medicine, Institute of Gastroenterology, Tokyo Women’s Medical University, Tokyo, Japan
- Dong Wan Seo
- Department of Internal Medicine, University of Ulsan College of Medicine, Seoul, Korea
- Takeshi Ogura
- Endoscopy Center, Osaka Medical and Pharmaceutical University, Osaka, Japan
- Raymond SY Tang
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China
- Pradermchai Kongkam
- ORCiD
- Division of Gastroenterology, Department of Medicine, Faculty of Medicine, Chulalongkorn University and Excellence Center for Gastrointestinal Endoscopy, King Chulalongkorn Memorial Hospital, Bangkok, Thailand
- Dadang Makmun
- Division of Gastroenterology, Department of Internal Medicine, Faculty of Medicine, University of Indonesia-Cipto Mangunkusumo National General Hospital, Jakarta, Indonesia
- Frederick Dy
- University of Santo Tomas Hospital, Manila, Philippines
- Wiriyaporn Ridtitid
- ORCiD
- Division of Gastroenterology, Department of Medicine, Faculty of Medicine, Chulalongkorn University and Excellence Center for Gastrointestinal Endoscopy, King Chulalongkorn Memorial Hospital, Bangkok, Thailand
- Yu Ting Kuo
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, College of Medicine, National Taiwan University and Hospital, Taipei, Taiwan
- Khanh Cong Pham
- University Medical Center at Ho Chi Minh city, Ho Chi Minh, Viet Nam
- Borathchakra Oung
- Department of Gastroenterology, Calmette Hospital, Phnom Penh, Cambodia
- Jeffrey Lee
- Department of Gastroenterology, Hepatology, and Nutrition, The University of Texas MD Anderson Cancer Center, Texas, USA
- Rungsun Rerknimitr
- ORCiD
- Center of Excellence for Innovation and Endoscopy in Gastrointestinal Oncology, Chulalongkorn University
- DOI
- https://doi.org/10.1055/a-2366-7302
- Journal volume & issue
-
Vol. 12,
no. 09
pp. E1065 – E1074
Abstract
The first Asia-Pacific consensus recommendations for endoscopic and interventional management of hilar cholangiocarcinoma were published in 2013. Since then, new evidence on the role of endoscopy for management of malignant hilar biliary obstruction (MHBO) has emerged. To update the recommendation, we reviewed the literature using a PICO (population/intervention/comparison/outcomes) framework and created consensus statements. The expert panel voted anonymously using the modified Delphi method and all final statements were evaluated for the quality of evidence and strength of recommendation. The important points with inadequate supporting evidence were classified as key concepts. There were seven statements and five key concepts that reached consensus. The statements and key concepts dealt with multiple aspects of endoscopy-based management in MHBO starting from diagnosis, strategies and options for biliary drainage, management of recurrent biliary obstruction, management of cholecystitis after biliary stenting, and adjunctive treatment before stenting. Although the recommendations may assist physicians in planning the treatment for MHBO patients, they should not replace the decision of a multidisciplinary team in the management of individual patients.
Keywords
- Pancreatobiliary (ERCP/PTCD)
- Strictures
- ERC topics
- Tissue diagnosis
- Endoscopic ultrasonography
- Biliary tract
- Intervention EUS
