# Adherence to ESGE guidelines on biliary stenting in malignant distal strictures: Results from a prospective Italian registry

## TL;DR

This study evaluated how well Italian endoscopic centers followed ESGE guidelines for managing malignant biliary strictures and found areas needing improvement.

## Contribution

The study provides a multicenter assessment of adherence to ESGE guidelines for biliary stenting in malignant strictures in Italy.

## Key findings

- Full adherence was observed for post-ERCP acute pancreatitis prophylaxis and retreatments.
- Poor adherence was found for preoperative drainage stent type and antibiotic prophylaxis use.

## Abstract

Distal malignant biliary strictures (dMBSs) are a common indication for endoscopic retrograde cholangiopancreatography (ERCP). The present study aimed to evaluate adherence of Italian endoscopic centers to European Society of Gastrointestinal Endoscopy (ESGE) guidelines on management of dMBS.

This prospective cohort, observational, multicenter study was promoted by the Italian Society of Digestive Endoscopy. All consecutive patients with dMBS were included in the registry. Clinical and technical data were recorded. Clinical follow-up was performed at 7 and 30 days, and then every 3 months. Adherence to the eight ESGE recommendations (defined as full-, intermediate- and poor-adherence if > 85%, ≥ 65% to ≤85%, and < 65%, respectively) was considered the primary outcome.

Seventeen Italian endoscopy centers were included. Between January 2020 and January 2022, 827 patients were included. Full adherence to the guidelines was reported for post-ERCP acute pancreatitis prophylaxis, retreatments, and preoperative biliary drainage. Intermediate adherence was reported for type of stent used in palliative drainage (85% SEMS and 15% plastic stents). Poor adherence was reported for type of stent used in preoperative drainage (56% self-expandable metal stents [SEMSs]), availability of pathological diagnosis in case of U-SEMS placement (45% of U-SEMSs placed without pathologically diagnosis), antibiotic prophylaxis (70.6%), and sphincterotomy (88%).

Adherence to ESGE guidelines needs to be improved in specific areas, including excessive use of plastic stents, use of U-SEMS without pathological diagnosis, and routine performance of sphincterotomy and use of antibiotic prophylaxis. (ClinicalTrials.gov ID: NCT05761496)