Clinical Endoscopy

Review

Self-expandable metal vs. plastic stents for preoperative biliary drainage in patients receiving neoadjuvant chemotherapy: Takashi Tamura, Reiko Ashida, Yuki Kawaji, Masahiro Itonaga, Yasunobu Yamashita, Masayuki Kitano; Clin Endosc 2025;58(6):817-825. Published online July 30, 2025; DOI: https://doi.org/10.5946/ce.2025.045

Abstract PDF Supplementary Material PubReader ePub: Neoadjuvant chemotherapy (NAC) improves the rate of curative resection and overall prognosis in patients with resectable or borderline resectable pancreatic cancer. The treatment period from the initiation of NAC to surgery typically ranges from 2 to 6 months. In cases of malignant biliary obstruction caused by pancreatic cancer, maintaining preoperative biliary drainage (PBD) until surgery is essential to continue NAC. Minimizing adverse events related to endoscopic biliary drainage and avoiding perioperative adverse events are crucial. Plastic stents (PSs) are commonly used for PBD; however, the extended duration of PBD required for NAC increases the risk of recurrent biliary obstruction (RBO), potentially leading to discontinuation of NAC. Therefore, preventing RBO during PBD in patients with pancreatic cancer receiving NAC is important. The placement of self-expandable metal stents (SEMSs) for PBD significantly reduces the rate of RBO compared with PS placement. Although SEMS placement may increase the risk of pancreatitis or cholecystitis, its effect on postoperative outcomes is comparable to that of PS placement. Given their lower rate of RBO, SEMSs are considered more suitable than PSs for PBD in patients with pancreatic cancer receiving NAC.

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Systematic Review and Meta-analysis

Efficacy of endoscopic ultrasound-guided biliary drainage of malignant biliary obstruction: a systematic review and meta-analysis of randomized controlled trials: Yousaf Zafar, Hafsa Azam, Muhammad Abdullah Bin Azhar, Fabeeha Shaheen, Syed Sarmad Javaid, Laila Manzoor, Muaaz Masood, Rajesh Krishnamoorthi; Clin Endosc 2025;58(4):533-543. Published online February 24, 2025; DOI: https://doi.org/10.5946/ce.2024.183

Graphical Abstract Abstract PDF Supplementary Material PubReader ePub

Background
/Aims: Malignant biliary obstruction is a major clinical challenge. We assessed the efficacy of endoscopic ultrasound-guided biliary drainage (EUS-BD) compared with that of endoscopic retrograde cholangiopancreatography biliary drainage (ERCP-BD) or percutaneous transhepatic biliary drainage (PTBD).
Methods
We searched for randomized controlled trials comparing EUS-BD with ERCP or PTBD in treating malignant biliary obstruction. Using random-effects models, we synthesized risk ratios (RRs) and weighted mean differences (WMDs) with 95% confidence intervals (CIs). A subgroup analysis was performed using a comparator (ERCP or PTBD).
Results
EUS-BD significantly reduced the risk of stent dysfunction (RR, 0.46; 95% CI, 0.33–0.64), with consistent results in subgroup analysis for ERCP (RR, 0.54; 95% CI, 0.35–0.84) and PTBD (RR, 0.37; 95% CI, 0.22–0.61). It also lowered the risk of post-procedure pancreatitis (RR, 0.24; 95% CI, 0.07–0.83) and reduced tumor ingrowth or overgrowth risk (RR, 0.27; 95% CI, 0.11–0.65), even when compared to ERCP alone (RR, 0.28; 95% CI, 0.11–0.70). EUS-BD demonstrated a lower risk of adverse events compared to PTBD (RR, 0.37; 95% CI, 0.14–0.97) and reduced length of hospital stay (WMD, –1.03; 95% CI, –1.53 to –0.53) when compared to ERCP.
Conclusions
EUS-BD outperformed ERCP-BD and PTBD in reducing stent dysfunction, postprocedural pancreatitis, and tumor ingrowth or overgrowth.

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Joan B. Gornals, Albert Sumalla-Garcia, Carme Loras
Clinical Gastroenterology and Hepatology.2025;[Epub] CrossRef

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Review

Endoscopic biliary drainage for distal bile duct obstruction due to pancreatic cancer: Masahiro Itonaga, Masayuki Kitano; Clin Endosc 2025;58(1):40-52. Published online September 26, 2024; DOI: https://doi.org/10.5946/ce.2023.294

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