Key result
The authors clarify their patient selection criteria for endoscopic ultrasound-guided biliary drainage, noting that ascites was a contraindication and chemotherapy's effect on stent patency remains unresolved.
This letter clarifies patient selection criteria and discusses the unresolved impact of chemotherapy on stent patency in endoscopic ultrasound-guided biliary drainage.
Letter to: Endoscopic ultrasound-guided transpapillary versus transluminal biliary stenting: randomized comparison of long-term stent patency Endoscopy 2026; 58(05): 493-502 DOI: 10.1055/a-2721-6292 10.1055/a-2721-6292 We read with interest the comments of Koji Takahashi regarding our study [ 1 ]. The author has raised important questions regarding patient accrual for prospective studies. With regard to patient selection, our policy dictates choosing patients who have a good performance status and have a life expectancy of more than 3 months. Asymptomatic patients (no pruritus) with poor general condition and those unfit to receive chemotherapy do not undergo biliary stenting. The presence of ascites has been a relative contraindication for endoscopic ultrasound-guided biliary drainage (EUS-BD), especially hepaticogastrostomy, as it interferes with fistula maturation and increases the risk of bile leak, bleeding, and stent migration [ 2 ]. Recent studies indicate that EUS-BD may be safely performed after draining ascites. However, our protocol was written in 2021; at this point in time, only a single pilot study, which was retrospective in nature, had attempted this procedure in patients with ascites [ 3 ]. For this reason, our protocol considered ascites as a contraindication for patient enrollment. The issue of stent patency and chemotherapy remains unresolved and was not part of our study. A study by Haal et al., which used metal stents, showed no difference in stent patency rates between groups of patients receiving or not receiving chemo(radio)therapy [ 4 ]. The study by Kang et al. [ 5 ], cited by the author, was a retrospective study with several methodological issues. There exists a clear dichotomy in the literature regarding the use of chemotherapy for the prevention of stent occlusion, with no clear answer. We believe that there is insufficient high-quality evidence to suggest that chemotherapy affects stent patency, and further prospective studies will be needed to resolve this issue. Publication History Article published online: 22 June 2026 © 2026. Thieme. All rights reserved. Georg Thieme Verlag KG Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany
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Dhir et al. (2026) conducted a letter in Biliary obstruction requiring stenting. Endoscopic ultrasound-guided biliary drainage (EUS-BD) was evaluated. The authors clarify their patient selection criteria for endoscopic ultrasound-guided biliary drainage, noting that ascites was a contraindication and chemotherapy's effect on stent patency remains unresolved.
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