Last updated March 15, 2022

Role of Endoscopy in the Management of Malignant Hilar Obstruction

Recommendations

In patients with unresectable MHO undergoing endoscopic palliative endoscopic stent placement, the panel suggests the following:
  • SEMSs compared with PSs in patients with a short life expectancy (<3 months) or those who place high value on avoiding repeated interventions.
  • PSs compared with SEMSs if an optimal drainage strategy has not been established.
  • Otherwise, either stent type may be used based on local expertise and physician preference.
( Low , Conditional (weak) )
612

In patients with unresectable MHO undergoing palliative endoscopic stent placement, the panel suggests placement of bilateral stents compared with a single unilateral stent. ( Low , Conditional (weak) )
612

In patients with MHO undergoing preoperative drainage, the panel suggests against routine use of PTBD as first-line therapy compared with EBD. ( Low , Conditional (weak) )
612

Recommendation 3b: In patients with unresectable MHO undergoing palliative drainage, the panel suggests EBD or PTBD. The final decision should be based on patient preferences, disease characteristics, and local expertise. ( Low , Conditional (weak) )
612

Recommendation Grading

Overview

Title

Role of Endoscopy in the Management of Malignant Hilar Obstruction

Authoring Organization

Publication Month/Year

May 20, 2021

Document Type

Guideline

Country of Publication

US

Inclusion Criteria

Male, Female, Adult, Older adult

Health Care Settings

Hospital, Operating and recovery room

Intended Users

Nurse, nurse practitioner, physician, physician assistant

Scope

Treatment, Management

Diseases/Conditions (MeSH)

D004724 - Endoscopy, D016099 - Endoscopy, Gastrointestinal, D017219 - Gastric Outlet Obstruction

Keywords

endoscopy, gastrointestinal endoscopy, hilar obstruction

Source Citation

Qumseya BJ, Jamil LH, Elmunzer BJ, Riaz A, Ceppa EP, Thosani NC, Buxbaum JL, Storm AC, Sawhney MS, Pawa S, Naveed M, Lee JK, Law JK, Kwon RS, Jue TL, Fujii-Lau LL, Fishman DS, Calderwood AH, Amateau SK, Al-Haddad M, Wani S. ASGE guideline on the role of endoscopy in the management of malignant hilar obstruction. Gastrointest Endosc. 2021 Aug;94(2):222-234.e22. doi: 10.1016/j.gie.2020.12.035. Epub 2021 May 20. PMID: 34023067.