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CC BY 4.0 · Endosc Int Open 2026; 14: a27779199
DOI: 10.1055/a-2777-9199
Original article

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

Authors

  • Tommaso Schepis

    1   Digestive Endoscopy Unit, Fondazione Policlinico Gemelli IRCCS – Catholic University, Rome, Italy

  • Rocco Maurizio Zagari 

    2   Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy (Ringgold ID: RIN9296)

  • Stefano Francesco Crinó 

    3   Pancreatic Diagnostic and Interventional Endoscopy Unit, University of Verona, Verona, Italy (Ringgold ID: RIN19051)

  • Marco Sacco 

    4   Endoscopy Unit, Gastroenterology Department, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Torino, Italy

  • Enrico Palmeri

    5   Pancreatic Diagnostic and Interventional Endoscopy Unit, University of Verona, Verona, Italy

  • Roberto Grassia

    6   UOSD Endoscopia Digestiva e Gastroenterologia, ASST di Cremona, Cremona, Italy

  • Alessio Santagati

    7   Dipartimento di Medicina, UOSD Gastroenterologia ed Endoscopia, P. O. G. Fogliani Milazzo, Milazzo, Italy

  • Giovanna Venezia

    8   U.O.C of Gastroenterology, Ospedale Santa Croce, Cuneo, Italy (Ringgold ID: RIN208961)

  • Nicola Olivari

    9   Digestive Endoscopy Unit and Gastroenterology, Fondazione Poliambulanza, Brescia, Italy

  • Alba Panarese 

    10   Division of Gastroenterology and Digestive Endoscopy, Department of Medical Sciences, Central Hospital-Azienda Ospedaliera, University “Aldo Moro” of Bari, Taranto, Italy

  • Massimiliano Mutignani

    11   Endoscopia Digestiva ed Interventistica, ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy

  • Ivano Biviano

    12   Gastroenterology and Interventional Endoscopy Unit, AOUS Policlinico S. Maria alle Scotte, Siena, Italy

  • Helga Bertani

    13   Gastroenterologia ed Endoscopia Digestiva, Azienda Ospedaliero Universitaria Policlinico di Modena, Modena, Italy

  • Massimo Devani

    14   Division of Gastroenterology and Digestive Endoscopy, ASST Rhodense, Rho, Italy (Ringgold ID: RIN472771)

  • Samuele de Minicis

    15   Gastroenterologia ed Endoscopia Digestiva Ospedale, Ospedale A. Murri, AST Fermo, Fermo, Italy

  • Giuseppe de Roberto

    16   Division of Endoscopy, European Institute of Oncology, Milan, Italy

  • Antonio Aucello

    17   UO Endoscopia Digestiva, Ospedale “M.G. Vannini”, Rome, Italy

  • Socrate Pallio

    18   Endoscopy Unit, G Martino University Hospital of Messina, Messina, Italy

  • Armando Gabbrielli

    19   UO Multizonale di Gastroenterologia ed Endoscopia Digestiva, APSS Ospedale Santa Chiara, Trento, Italy

  • Sebastian Manuel Milluzzo 

    20   Digestive Endoscopy Unit and Gastroenterology, Fondazione Poliambulanza, Brescia, Italy

  • Maria Caterina Parodi

    21   IRCCS University Hospital San Martino-IST National Institute for Cancer Research, Gastroenterology and Digestive Endoscopic Unit, Genova, Italy

  • Luigi Pasquale

    22   UOC Gastroenterologia ed Endoscopia Digestiva, ASL Avellino, Italy

  • Guido Costamagna 

    23   Digestive Endoscopy Unit, Catholic University, Rome, Italy
    24   Endoscopy Unit, Ospedale Isola Tiberina - Gemelli Isola, Rome, Italy

  • Elton Dajti 

    2   Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy (Ringgold ID: RIN9296)

  • Andrea Tringali 

    1   Digestive Endoscopy Unit, Fondazione Policlinico Gemelli IRCCS – Catholic University, Rome, Italy
    25   Centre for Endoscopic Research, Therapeutics and Training (CERTT), Rome, Italy
    • and the PROTESIED Study Group

Clinical Trial:

Registration number (trial ID): NCT05761496, Trial registry: ClinicalTrials.gov (http://www.clinicaltrials.gov/), Type of Study: Prospective study


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Abstract

Background and study aims

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.

Patients and methods

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.

Results

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%).

Conclusions

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)

Keywords

Pancreatobiliary (ERCP/PTCD) - Strictures - ERC topics - Tissue diagnosis

Supplementary Material



Publication History

Received: 31 March 2025

Accepted after revision: 17 November 2025

Accepted Manuscript online:
22 December 2025

Article published online:
26 January 2026

© 2026. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/).

Georg Thieme Verlag KG
Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany

Bibliographical Record
Tommaso Schepis, Rocco Maurizio Zagari, Stefano Francesco Crinó, Marco Sacco, Enrico Palmeri, Roberto Grassia, Alessio Santagati, Giovanna Venezia, Nicola Olivari, Alba Panarese, Massimiliano Mutignani, Ivano Biviano, Helga Bertani, Massimo Devani, Samuele de Minicis, Giuseppe de Roberto, Antonio Aucello, Socrate Pallio, Armando Gabbrielli, Sebastian Manuel Milluzzo, Maria Caterina Parodi, Luigi Pasquale, Guido Costamagna, Elton Dajti, Andrea Tringali. Adherence to ESGE guidelines on biliary stenting in malignant distal strictures: Results from a prospective Italian registry. Endosc Int Open 2026; 14: a27779199.
DOI: 10.1055/a-2777-9199
 

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