NICE issues recommendations for biliary drainage in pancreatic and bile duct cancers

April 24, 2023

Patients suffering from malignant distal biliary obstruction will continue to benefit from endoscopic ultrasound guided biliary drainage (EUS-BD) following guidance from the National Institute for Health and Care Excellence (NICE), the UK health body that provides recommendations to improve health and social care1. Malignant distal biliary obstructions can be caused by pancreatic and bile duct cancers which are severe and aggressive.

NICE reviewed the evidence on the safety and efficacy of EUS-BD, which included the Boston Scientific Hot Axios™ Stent and Electrocautery-Enhanced Delivery System. NICE concluded that EUS-BD can be used provided that standard arrangements are in place for clinical governance, consent and audit. NICE is satisfied with the evidence of safety and efficacy so that doctors may now offer this minimally invasive procedure to patients.

First line decompression treatment for these cancers is endoscopic retrograde cholangiopancreatography (ERCP) which fails in 10–20% of patients, usually because of difficult anatomy2. Where an ERCP is not successful, patients are offered percutaneous biliary drainage. EUS-BD provides another option using Hot Axios.

“This NICE guidance provides patients with an alternative pathway in the UK healthcare system to manage the pain and discomfort of their disease,” said Astrid Monteau, vice president of  Endoscopy in Europe, Middle East and Africa. “By reducing the amount of interventions that patients require, Hot Axios brings a cost benefit and improves the experience of the patient pathway. Our strict selection criteria to train clinicians experienced in the use of endoscopic ultrasound techniques ensures there is a collaborative and multidisciplinary team support within the hospital to use this product.”

Data from Cancer Research UK lists pancreatic cancer as the tenth most common cancer in the UK, accounting for 3% of all new cancer cases (2016-2018) and it is projected to rise by 5% between 2023-2025 and 2038-20403. Bile duct cancer is rare and there is no UK data on survival rates4. Hot Axios is available in Hepato-Pancreato-Biliary centres, including London, Leeds, and Nottingham.

 

References

  1. NICE guidelines
  2. Dumonceau JM, Tringali A, Papanikolaou IS, Blero D, Mangiavillano B, Schmidt A, et al. Endoscopic biliary stenting: indications, choice of stents, and results: European Society of Gastrointestinal Endoscopy (ESGE) Clinical Guideline—updated October 2017. Endoscopy. 2018;50:910–930
  3. Pancreatic cancer statistics | Cancer Research UK
  4. Survival for bile duct cancer | Cancer Research UK