{
  "abstract": "Endoscopic retrograde cholangiopancreatography (ERCP), with biliary brushings and deployment of a fully covered self-expanding metal stent, remains the standard of care to treat malignant distal biliary obstruction (MDBO) due to cancers of the pancreas, bile duct and ampulla.1–3 ERCP is, however, often unsuccessful in patients with duodenal stenosis, ampullary infiltration or high-grade biliary strictures. In spite of expertise, the rate of procedure-related pancreatitis in this cohort, reported as 7.2% in a recent meta-analysis,4 remains significant and can result in devastating delays to treatment. Even with the adoption of optimisation techniques, biliary brushings remain suboptimal with sensitivity rates in the region of 60%.5",
  "authors": [
    {
      "affiliations": [
        "Gastroenterology, Leeds Teaching Hospitals NHS Trust, Leeds, West Yorkshire, UK"
      ],
      "name": "Neil O’Morain"
    },
    {
      "affiliations": [
        "Leeds Teaching Hospitals NHS Trust, Leeds, Leeds, UK"
      ],
      "name": "Wei On"
    },
    {
      "affiliations": [
        "Gastroenterology, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, Newcastle upon Tyne, UK"
      ],
      "name": "Manu Nayar"
    },
    {
      "affiliations": [
        "Gastroenterology, University College London Medical School, London, UK"
      ],
      "name": "Gavin Johnson"
    },
    {
      "affiliations": [
        "Gastroenterology, Hillingdon Hospitals NHS Foundation Trust, Uxbridge, UK"
      ],
      "name": "Danujan Sriranganathan"
    },
    {
      "affiliations": [
        "Gastroenterology, Royal Stoke University Hospital, Stoke-on-Trent, UK"
      ],
      "name": "Srisha Hebbar"
    },
    {
      "affiliations": [
        "Gastroenterology, Royal Stoke University Hospital, Stoke-on-Trent, UK"
      ],
      "name": "Shabbir Jivanjee"
    },
    {
      "affiliations": [
        "Radiology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK"
      ],
      "name": "Edmund Godfrey"
    },
    {
      "affiliations": [
        "Radiology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK"
      ],
      "name": "Vasileios Galanakis"
    },
    {
      "affiliations": [
        "Pancreaticobiliary Medicine Unit, UCLH, London, London, UK"
      ],
      "name": "Harry Martin"
    },
    {
      "affiliations": [
        "The Centre for Liver and Digestive Disorders, Royal Infirmary of Edinburgh, Edinburgh, UK"
      ],
      "name": "Aaron P McGowan"
    },
    {
      "affiliations": [
        "The Centre for Liver and Digestive Disorders, Royal Infirmary of Edinburgh, Edinburgh, UK"
      ],
      "name": "Ashwin Patwardhan"
    },
    {
      "affiliations": [
        "Gastroenterology, Manchester University NHS Foundation Trust, Manchester, UK"
      ],
      "name": "Joe Geraghty"
    },
    {
      "affiliations": [
        "Gastroenterology, Manchester University NHS Foundation Trust, Manchester, UK"
      ],
      "name": "Kini Geogry"
    },
    {
      "affiliations": [
        "Gastroenterology, Manchester University NHS Foundation Trust, Manchester, UK"
      ],
      "name": "Sajjad Mahmood"
    },
    {
      "affiliations": [
        "Gastroenterology, Manchester University NHS Foundation Trust, Manchester, UK"
      ],
      "name": "Korani Mohamed"
    },
    {
      "affiliations": [
        "Department of Hepatology, University Hospital Southampton NHS Foundation Trust, Southampton, Hampshire, UK"
      ],
      "name": "Nadeem Tehami"
    },
    {
      "affiliations": [
        "NIHR Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK",
        "University of Nottingham, Nottingham, UK"
      ],
      "name": "Suresh V Venkatachalapathy"
    },
    {
      "affiliations": [
        "NIHR Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK"
      ],
      "name": "Nasir Javed"
    },
    {
      "affiliations": [
        "Gastroenterology, John Radcliffe Hospital, Oxford, Oxfordshire, UK",
        "John Radcliffe Hospital, Oxford, UK"
      ],
      "name": "Noor Bekkali"
    },
    {
      "affiliations": [
        "Gastroenterology, Leeds Teaching Hospitals NHS Trust, Leeds, West Yorkshire, UK"
      ],
      "name": "Bharat Paranandi"
    },
    {
      "affiliations": [
        "Gastroenterology, Leeds Teaching Hospitals NHS Trust, Leeds, West Yorkshire, UK"
      ],
      "name": "Simon M Everett"
    },
    {
      "affiliations": [
        "Pancreatico-biliary Surgery, Leeds Teaching Hospitals NHS Trust, Leeds, Leeds, UK"
      ],
      "name": "Andrew Smith"
    },
    {
      "affiliations": [
        "Gastroenterology, Leeds Teaching Hospitals NHS Trust, Leeds, West Yorkshire, UK"
      ],
      "name": "Matthew T Huggett"
    }
  ],
  "title": "Is it time for a paradigm change in the management of malignant distal biliary obstruction in the UK?",
  "uid": "98b57a96-d7d4-5b6d-9e53-efcb5897ec38"
}