Informed Consent for Endoscopic Biliary Drainage: Time for a New Paradigm

Area of Science:

• Gastroenterology
• Interventional Endoscopy

Background:

• Malignant biliary obstruction management often starts with ERCP.
• Percutaneous transhepatic biliary drainage (PTBD) is the traditional rescue for ERCP failure.
• Endoscopic ultrasound-guided biliary drainage (EUS-BD) shows comparable success to PTBD.

Purpose of the Study:

• To discuss the integrated roles of ERCP and EUS in biliary drainage.
• To guide the development of informed consent for these procedures.

Main Methods:

• Review of current literature on ERCP, PTBD, and EUS-BD.
• Analysis of technical success rates and clinical outcomes.
• Discussion of the evolving biliopancreatic paradigm.

Main Results:

• EUS-BD demonstrates high technical success rates, similar to PTBD.
• ERCP and EUS are increasingly interconnected for biliary interventions.
• Informed consent is a critical emerging issue.

Conclusions:

• EUS-BD is a strong alternative to PTBD for malignant biliary obstruction.
• A comprehensive understanding of ERCP and EUS roles is essential.
• Developing appropriate informed consent is crucial for patient care.