Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Endosc. Oct 16, 2022; 14(10): 581-596
Published online Oct 16, 2022. doi: 10.4253/wjge.v14.i10.581
Endoscopic palliation of malignant biliary obstruction
Andrew Canakis, Michel Kahaleh
Andrew Canakis, Department of Gastroenterology and Hepatology, University of Maryland School of Medicine, Baltimore, MD 21201, United States
Michel Kahaleh, Department of Gastroenterology and Hepatology, Robert Wood Johnson Medical Center, New Brunswick, NJ 08901, United States
Author contributions: Canakis A was responsible of drafting and reference editing; Kahaleh M was responsible for concept, final drafting, and final approval of manuscript.
Conflict-of-interest statement: Dr. Kahaleh is a consultant for Boston Scientific, Medtronic and Abvvie, he has received research grant from Boston Scientific, Apollo, Olympus, Cook, Microtech and Fuji; Dr Canakis has no disclose.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Corresponding author: Michel Kahaleh, AGAF, FACG, FASGE, MD, Professor, Department of Gastroenterology and Hepatology, Robert Wood Johnson Medical Center, 1 Robert Wood Johnson Place, New Brunswick, NJ 08901, United States.
Received: July 3, 2022
Peer-review started: July 3, 2022
First decision: August 1, 2022
Revised: August 20, 2022
Accepted: October 4, 2022
Article in press: October 4, 2022
Published online: October 16, 2022

Malignant biliary obstruction often presents with challenges requiring the endoscopist to assess the location of the lesion, the staging of the disease, the eventual resectability and patient preferences in term of biliary decompression. This review will focus on the different modalities available in order to offer the most appropriate palliation, such as conventional endoscopic retrograde cholangiopancreatography, endoscopic ultrasound guided biliary drainage as well as ablative therapies including photodynamic therapy or radiofrequency ablation.

Keywords: Biliary obstruction, Endoscopic retrograde cholangiopancreatography, Endoscopic ultrasonography, Stenting, Ablation therapy

Core Tip: Endoscopic palliation of malignant biliary obstruction can often be challenging. Endoscopic retrograde cholangiopancreatography remains the gold standard for biliary decompression. Its widespread use and high success rate, especially in expert hands, makes it an effective modality for biliary decompression. Yet, recent advances in endoscopic ultrasound guided biliary drainage have emerged from a rescue therapy to a reliable tool with high technical and clinical success rates with moderate adverse event rates. Growing evidence suggest that this can be considered as a first line option in the future. Lastly, photodynamic therapy and radiofrequency ablation of the bile duct can also optimize stent patency, palliate symptoms and prolong survival. While there are limited head to head studies, radiofrequency ablation may be a more cost effective option with lower adverse events.