Endoscopy 2018; 50(09): 910-930
DOI: 10.1055/a-0659-9864
Guideline
© Georg Thieme Verlag KG Stuttgart · New York

Endoscopic biliary stenting: indications, choice of stents, and results: European Society of Gastrointestinal Endoscopy (ESGE) Clinical Guideline – Updated October 2017

Jean-Marc Dumonceau
 1  Gedyt Endoscopy Center, Buenos Aires, Argentina
,
Andrea Tringali
 2  Digestive Endoscopy Unit, Catholic University, Rome, Italy
,
Ioannis S. Papanikolaou
 3  Hepatogastroenterology Unit, Second Department of Internal Medicine – Propaedeutic, Research Institute and Diabetes Center, Medical School, National and Kapodistrian University, Attikon University General Hospital, Athens, Greece
,
Daniel Blero
 4  CHU Charleroi et Vésale, ISPPC, Charleroi, Belgium
,
Benedetto Mangiavillano
 5  Gastrointestinal Endoscopy Unit, Humanitas Mater Domini, Castellanza, Italy - Humanitas University, Milan, Italy
,
Arthur Schmidt
 6  Department of Gastroenterology, Klinikum Ludwigsburg, University of Heidelberg, Germany
,
Geoffroy Vanbiervliet
 7  Department of Gastroenterology and Endoscopy, Hôpital Universitaire l’Archet, Nice, France
,
Guido Costamagna
 8  Digestive Endoscopy Unit Catholic University, Rome, Italy
,
Jacques Devière
 9  Department of Gastroenterology Hepatopancreatology, and Digestive Oncology, Erasme University Hospital, Université Libre de Bruxelles, Brussels, Belgium
,
Jesús García-Cano
10  Department of Digestive Diseases, Hospital Virgen de La Luz, Cuenca, Spain
,
Tibor Gyökeres
11  Department of Gastroenterology, Medical Center, Hungarian Defense Forces, Budapest, Hungary
,
Cesare Hassan
12  Digestive Endoscopy Unit, Catholic University, Rome, Italy
,
Frédéric Prat
13  Gastroenterology Unit, Hôpital Cochin (AP-HP), Paris, France
,
Peter D. Siersema
14  Department of Gastroenterology and Hepatology, Radboud University Medical Center, Nijmegen, The Netherlands
,
Jeanin E. van Hooft
15  Department of Gastroenterology and Hepatology, Amsterdam UMC, University of Amsterdam, The Netherlands
› Author Affiliations
Further Information

Publication History

Publication Date:
07 August 2018 (eFirst)

Main Recommendations

ESGE recommends against routine preoperative biliary drainage in patients with malignant extrahepatic biliary obstruction; preoperative biliary drainage should be reserved for patients with cholangitis, severe symptomatic jaundice (e. g., intense pruritus), or delayed surgery, or for before neoadjuvant chemotherapy in jaundiced patients.
Strong recommendation, moderate quality evidence.

ESGE recommends the endoscopic placement of a 10-mm diameter self-expandable metal stent (SEMS) for preoperative biliary drainage of malignant extrahepatic biliary obstruction.
Strong recommendation, moderate quality evidence.

ESGE recommends SEMS insertion for palliative drainage of of extrahepatic malignant biliary obstruction.
Strong recommendation, high quality evidence.

ESGE recommends against the insertion of uncovered SEMS for the drainage of extrahepatic biliary obstruction of unconfirmed etiology.
Strong recommendation, low quality evidence.

ESGE suggests against routine preoperative biliary drainage in patients with malignant hilar obstruction.
Weak recommendation, low quality evidence.

ESGE recommends uncovered SEMSs for palliative drainage of malignant hilar obstruction.
Strong recommendation, moderate quality evidence.

ESGE recommends temporary insertion of multiple plastic stents or of a fully covered SEMS for treatment of benign biliary strictures.
Strong recommendation, moderate quality evidence.

ESGE recommends endoscopic placement of plastic stent(s) to treat bile duct leaks that are not due to transection of the common bile duct or common hepatic duct.
Strong recommendation, moderate quality evidence.

Appendix e1, Tables e1 – e5