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CC BY-NC-ND 4.0 · Endosc Int Open 2017; 05(08): E754-E762
DOI: 10.1055/s-0043-111592
Original article
Eigentümer und Copyright ©Georg Thieme Verlag KG 2017

Survey study on the practice patterns in the endoscopic management of malignant distal biliary obstruction

Dennis Yang
1   Division of Gastroenterology and Hepatology, University of Florida, Gainesville, FL, USA
,
Yaseen B. Perbtani
1   Division of Gastroenterology and Hepatology, University of Florida, Gainesville, FL, USA
,
Qi An
2   Department of Health Outcomes and Policy, University of Florida, Gainesville, FL, USA
,
Mitali Agarwal
3   Department of Medicine, University of Florida, Gainesville, FL, USA
,
Michael Riverso
1   Division of Gastroenterology and Hepatology, University of Florida, Gainesville, FL, USA
,
Joydeep Chakraborty
3   Department of Medicine, University of Florida, Gainesville, FL, USA
,
Tony S. Brar
3   Department of Medicine, University of Florida, Gainesville, FL, USA
,
Donevan Westerveld
3   Department of Medicine, University of Florida, Gainesville, FL, USA
,
Han Zhang
3   Department of Medicine, University of Florida, Gainesville, FL, USA
,
Shailendra S. Chauhan
4   CHS Digestive Health, Carolinas Medical Center, Charlotte, NC, USA
,
Christopher E. Forsmark
1   Division of Gastroenterology and Hepatology, University of Florida, Gainesville, FL, USA
,
Peter V. Draganov
1   Division of Gastroenterology and Hepatology, University of Florida, Gainesville, FL, USA
› Author Affiliations
Further Information

Publication History

submitted 03 January 2017

accepted after revision 23 March 2017

Publication Date:
07 August 2017 (online)

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Abstract

Background and study aim Endoscopic biliary drainage for malignant distal biliary obstruction (MDBO) is a common practice. Controversy persists with regard to its role in resectable MDBO, the optimal technical method and type of stent. The aim of this study was to evaluate practice patterns in the treatment of MDBO among endoscopists with varying levels of experience and practice backgrounds.

Methods Electronic survey distributed to members of the American Society for Gastrointestinal Endoscopy (ASGE). The main outcome measures included practice setting (academic vs. community), volume of endoscopic retrograde cholangiopancreatographies (ERCPs), reasons for endoscopic drainage in MDBO, and technical approach.

Results A total of 335 subjects (54 % community-based endoscopists) completed the survey. Most academic physicians (69 %) reported performing ≥ 150 ERCPs annually compared to 18.8 % of community physicians (P < 0.001). In aggregate, 13.1 % of respondents performed ERCP in resectable MDBO because of surgeon preference or as the standard of care at their institution. The use of metal vs. plastic stents in MDBO varied based on practice setting. Routine sphincterotomy for MDBO was more common among community (78 %) vs academic endoscopists (61.1 %) (P < 0.001). Over half (58 %) of the subjects avoided covering the cystic duct take-off during stenting MDBO if there was a gallbladder in situ.

Conclusion There is significant variability in practice patterns for the treatment of MDBO. In spite of the recent ASGE guideline recommendations, some patients with resectable MDBO still undergo preoperative ERCP. Current clinical practices are not clearly supported by available data and underscore the need to increase adherence to gastrointestinal societal recommendations and an evidence-based approach to standardized patient care.

 

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