Book chapter
41 - Endoscopic approaches to concomitant malignant biliary obstruction and gastric outlet obstruction
ERCP, pp.447-464.e5
Elsevier Inc, Fourth Edition
2024
DOI: 10.1016/B978-0-323-93362-9.00050-3
Abstract
Biliary obstruction (BO) and gastric outlet obstruction (GOO) are common complications of advanced pancreatic cancer. Reestablishing both biliary and luminal patency is of utmost importance for successful management and palliation of these patients. Endoscopic retrograde cholangiopancreatography (ERCP) is often challenging in cases of malignant BO, especially when associated with GOO. In this chapter, we discuss the endoscopic approach to the management of both malignant BO (MBO) and GOO when they occur separately and in combination. We describe the importance of proper anatomic understanding and classification of GOO, which largely determines the most appropriate endoscopic route. Optimal stent selection; the timing and order of biliary and enteral stent insertion; advanced techniques, such as performing ERCP through an existing enteral stent; and endoscopic ultrasound (EUS)-guided interventions are thoroughly discussed. Finally, we review the techniques and the up-to-date literature regarding EUS-guided gastroenterostomy in GOO and EUS-guided biliary drainage for MBO.
Details
- Title: Subtitle
- 41 - Endoscopic approaches to concomitant malignant biliary obstruction and gastric outlet obstruction
- Creators
- Rami G. El AbiadApurva ShrigiriwarTodd H. BaronMouen A. Khashab
- Resource Type
- Book chapter
- Publication Details
- ERCP, pp.447-464.e5
- Edition
- Fourth Edition
- Publisher
- Elsevier Inc; Philadelphia, PA
- DOI
- 10.1016/B978-0-323-93362-9.00050-3
- Language
- English
- Date published
- 2024
- Academic Unit
- Gastroenterology and Hepatology; Internal Medicine
- Record Identifier
- 9984687785702771
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