Redefining endoluminal biliary drainage: Challenges and innovations in endosonography-guided techniques

Figure 1 Management algorithm in hilar cholangiocarcinoma[22]. Citation: Angsuwatcharakon P, Kulpatcharapong S, Chuncharunee A, Khor C, Devereaux B, Moon JH, Ratanachu-Ek T, Wang HP, Pausawasdi N, Maydeo A, Itoi T, Ponnudurai R, Ramchandani M, Nakai Y, Seo DW, Ogura T, Tang RS, Kongkam P, Makmun D, Dy F, Ridtitid W, Kuo YT, Pham KC, Oung B, Lee J, Rerknimitr R. The updated Asia-Pacific consensus statement on the role of endoscopic management in malignant hilar biliary obstruction. Endosc Int Open 2024; 12: E1065-E1074. Copyright^© The Authors 2024. Published by Thieme. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon (https://creativecommons.org/licenses/by-nc-nd/4.0/). One asterisk: Preoperative biliary drainage may be indicated in patients with cholangitis, prolonged jaundice, delayed surgery [e.g., waiting for portal vein intervention, malnutrition (serum albumin less than 3 g/dL), etc.], or total bilirubin ≥ 15 mg/dL; Two asterisks: Wire-guided selection of preselected liver segment before performing cholangiogram, followed by air/carbon dioxide cholangiogram or limited injection with contrast media. Photodynamic therapy or endo-biliary radiofrequency ablation may be used as adjunctive treatment before stenting. MDCT: Multidetector-row computed tomography; MRCP: Magnetic resonance cholangiopancreatography; ERCP: Endoscopic retrograde cholangiopancreatography; PTBD: Percutaneous transhepatic biliary drainage; SEMS: Self-expandable metal stents; EUS-GBD: Endosonography-guided gallbladder drainage; PTC: Percutaneous cholecystostomy.