Enteroscopy‑ERCP Cannot Replace the Role of Percutaneous Transhepatic Biliary Drains in Treating Biliary‑Enteric Anastomotic Strictures
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To the Editor,
We read the important article by Hammad et al.  with great interests. The authors have done a great job of comparing the application result of enteroscopy‑ERCP and PTBD in treating biliary-enteric anastomotic strictures. The authors draw the conclusion that E‑ERCP should be considered as an alternative to PTBD in AS treatment. This conclusion is disputed and not acceptable to our knowledge.
As the authors said, initial decision making in selecting the treatment was solely based on referring physician’s preference. Indications for choosing E‑ERCP or PTBD were based on upstream biliary ductal dilatation and elevated hepatic enzymes. Patients with severe bile duct enlargement were more likely to receive PTBD treatment. Severe enlargement of the bile duct would lead to higher elevated hepatic enzyme levels. In this article, a more than 50% LFTs reduction was thought as a significant clinical improvement. As a result, the PTBD treatment group will need a relative longer...
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Conflict of interest
The authors declare that they have no conflict of interest.
- 1.Hammad H, Brauer BC, Smolkin M, Ryu R, Obuch J, Shah RJ. Treating biliary-enteric anastomotic strictures with enteroscopy-ERCP requires fewer procedures than percutaneous transhepatic biliary drains. Dig Dis Sci. 2019;64:2638–2644. https://doi.org/10.1007/s00330-018-5776-5.CrossRefPubMedGoogle Scholar