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Updated: May 12, 2026
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Endoscopic Ultrasound-Guided Biliary Drainage: Endoscopic Ultrasound-Guided Hepaticogastrostomy in Malignant Biliary Obstruction
Published on: March 25, 2022
Otaru consensus on biliary stenting for unresectable distal malignant biliary obstruction
Atsushi Irisawa1, Akio Katanuma, Takao Itoi
1Department of Gastroenterology, Fukushima Medical University Aizu Medical Center, Aizuwakamatsu, Japan. irisawa@fmu.ac.jp
Summary
This consensus meeting on biliary stenting for malignant obstruction found agreement on self-expandable metallic stents and reintervention. However, opinions differed on sphincterotomy necessity and covered versus uncovered metal stents.
Area of Science:
- Gastroenterology
- Endoscopy
- Oncology
Background:
- Malignant biliary obstruction often requires endoscopic biliary drainage with stent placement for palliation.
- A lack of consensus exists regarding optimal stent type (covered vs. uncovered metal, plastic vs. metal) for distal bile duct obstructions.
Purpose of the Study:
- To achieve consensus on key aspects of biliary stenting for distal malignant biliary obstruction.
- To discuss and propose new statements based on expert opinion and evidence.
Main Methods:
- A consensus meeting was held at the Endoscopic Forum Japan 2012, following 2012 European Society of Gastrointestinal Endoscopy guidelines.
- Four selected statements regarding stent placement for distal malignant biliary obstruction were discussed by participants.
Main Results:
- Agreement was reached on the usefulness of self-expandable metallic stents and reintervention strategies.
- Divergent opinions persisted regarding the necessity of sphincterotomy and the choice between covered and uncovered metal stents.
Conclusions:
- While consensus was achieved on some aspects of biliary stenting, significant debate remains on other critical treatment decisions.
- Further discussion and evidence are needed to establish clear guidelines for stent selection and procedural techniques in malignant biliary obstruction.
