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CC BY-NC-ND 4.0 · Endosc Int Open
DOI: 10.1055/a-2366-7302
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The updated Asia-Pacific consensus statement on the role of endoscopic management in malignant hilar biliary obstruction.

Phonthep Angsuwatcharakon 
1   Internal medicine, King Chulalongkorn Memorial Hospital, Bangkok, Thailand
,
Santi Kulpatcharapong
2   Medicine, King Chulalongkorn Memorial Hospital, Bangkok, Thailand (Ringgold ID: RIN176044)
,
Alan Chuncharunee
3   Medicine, Mahidol University Faculty of Medicine Ramathibodi Hospital, Bangkok, Thailand (Ringgold ID: RIN26687)
,
Christopher Khor
4   Gastroenterology & Heptology, Singapore General Hospital, Singapore, Singapore
,
Benedict Devereaux
5   Royal Brisbane and Women's Hospital, The University of Queensland, Brisbane, Australia (Ringgold ID: RIN1974)
,
Jong Ho Moon
6   Digestive Disease Center and Research Institute, Department of Internal Medicine, SoonChunHyang University School of Medicine, Bucheon, Korea (the Republic of)
,
Thawee Ratanachu-ek
7   Surgery, Rajavithi Hospital, Bangkok, Thailand (Ringgold ID: RIN54781)
,
Hsiu Po Wang
8   Internal medicine, National Taiwan University Hospital, Taipei, Taiwan (Ringgold ID: RIN38006)
,
Nonthalee Pausawasdi
9   Medicine, Mahidol University Faculty of Medicine Siriraj Hospital, Bangkok, Thailand (Ringgold ID: RIN65106)
,
Amit Maydeo 
10   Institute of Gastrosciences, Sir HN Reliance Foundation Hospital and Research Centre, Mumbai, India (Ringgold ID: RIN81727)
,
Takao Itoi
11   Fourth Department of Internal Medicine, Tokyo Medical University, Tokyo, Japan
,
Ryan Ponnudurai
12   Gastroenterology, Prince Court Medical Centre, Kuala Lumpur, Malaysia (Ringgold ID: RIN124935)
,
Mohan Ramchandani
13   Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, India (Ringgold ID: RIN78470)
14   Asian Institute of Gastroenterology, Hyderabad, India (Ringgold ID: RIN78470)
,
Yousuke Nakai 
15   Gastroenterology, The University of Tokyo, Tokyo, Japan
,
Dong Wan Seo
16   Internal medicine, University of Ulsan College of Medicine, Seoul, Korea (the Republic of)
,
Takeshi Ogura
17   2nd Department of Internal Medicine, Osaka Medical College, Takatsuki-shi, Japan
,
Raymond SY Tang
18   Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Shatin, Hong Kong
,
Pradermchai Kongkam 
19   Medicine, Chulalongkorn University, Bangkok, Thailand (Ringgold ID: RIN26683)
,
Dadang Makmun
20   University of Indonesia-Cipto Mangunkusumo National General Hospital, Univ Indonesia, Jakarta, Indonesia
,
Frederick Dy
21   University of Santo Tomas Hospital, Manila, Philippines (Ringgold ID: RIN125866)
,
Wiriyaporn Ridtitid 
22   Medicine, Chulalongkorn University, Bangkok, Thailand (Ringgold ID: RIN26683)
,
Yu Ting Kuo
8   Internal medicine, National Taiwan University Hospital, Taipei, Taiwan (Ringgold ID: RIN38006)
,
Khanh Cong Pham
23   University Medical Center at Ho Chi Minh city, Ho Chi Minh, Viet Nam
,
Borathchakra Oung
24   gastroenterology and endoscopy, Pavillon L Edouard Herriot Hospital, Lyon, France
25   CAGE, Cambodian Association of Gastrointestinal Endoscopy, Phnom Penh, Cambodia
,
Jeffrey Lee
26   Gastroenterology, hepatology and nutrition, The University of Texas MD Anderson Cancer Center, Houston, United States (Ringgold ID: RIN4002)
,
Rungsun Rerknimitr 
27   Department of Medicine, Chulalongkorn University, Bangkok, Thailand
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The first Asia–Pacific consensus recommendations for endoscopic and interventional management of hilar cholangiocarcinoma were published in 2013. Since then, new evidence on the role of endoscopy for management of malignant hilar biliary obstruction (MHBO) has emerged. To update the recommendation, we reviewed the literature using a PICO (population/intervention/comparison/outcomes) framework and created consensus statements. The expert panel voted anonymously using the modified Delphi method, and all final statements were evaluated for the quality of evidence and strength of recommendation. The important points with inadequate supporting evidence were classified as key concepts. There were 7 statements and 5 key concepts that reached consensus. The statements and key concepts dealt with multiple aspects of endoscopy-based management in MHBO starting from diagnosis, strategies and options for biliary drainage, management of recurrent biliary obstruction, management of cholecystitis after biliary stenting, and adjunctive treatment before stenting. Although the recommendations may assist physicians in planning the treatment for MHBO patients, they should not replace the decision of a multidisciplinary team in the management of individual patients.



Publication History

Received: 10 May 2024

Accepted: 15 July 2024

Accepted Manuscript online:
16 July 2024

© . The Author(s). 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/).

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