# Transpapillary biliary drainage using a forward-viewing endoscope for patients with distal malignant biliary obstruction and type I duodenal stenosis

## TL;DR

This study shows that using a forward-viewing endoscope for biliary drainage is effective and safe in patients with duodenal stenosis and biliary obstruction.

## Contribution

The study introduces transpapillary biliary drainage using a forward-viewing endoscope as a novel approach for patients with type I duodenal stenosis.

## Key findings

- Biliary cannulation and drainage were successful in all 17 sessions using a forward-viewing endoscope.
- Hyperamylasemia occurred in 3 out of 17 sessions as the main adverse event.

## Abstract

Distal malignant biliary obstruction and duodenal stenosis may be complicated in patients with pancreaticobiliary cancer. It is often difficult to insert a side-viewing duodenoscope and perform transpapillary biliary drainage in patients with duodenal stenosis on the oral side of the major papilla; hence, in this study, we attempted transpapillary biliary drainage using a forward-viewing endoscope and reported its efficacy and safety.

This retrospective single-center cohort study included 12 patients (17 sessions) who underwent transpapillary biliary drainage using a forward-viewing endoscope between April 2020 and October 2024. The tip of the forward-viewing endoscope was inverted around the inferior duodenal angulus and the major papilla was viewed from the anal side. We evaluated patient characteristics, outcomes, and adverse events (AEs) during these procedures.

Biliary cannulation and drainage were successful in all cases, with a median cannulation and procedure time of 7 minutes (range 0.5–34) and 33 minutes (range 10–101), respectively. Median biliary cannulation time required was 3.5 minutes (range 0.5–15) for 10 sessions in patients with a history of endoscopic sphincterotomy and 9 minutes (range 4–34) for seven sessions in patients with native papilla (
P
= 0.01). The types of biliary drainage were plastic stent in nine sessions, endoscopic nasobiliary drainage in two sessions, and self-expandable metal stent in six sessions. Hyperamylasemia as AEs occurred in three sessions.

Transpapillary biliary drainage using a forward-viewing endoscope is a useful option for patients with type I duodenal stenosis.