Types of Self-Expandable Metal Stents for Palliative Drainage of Unresectable Extrahepatic Malignant Biliary Obstruction: A Network Meta-Analysis of Randomized Controlled Trials.
Emergingsuggested applicable standard· American College of Gastroenterology, 'Diagnosis and Management of Choledocholithiasis', 2019
Decision at stakethe choice of self-expandable metal stents for palliative drainage of unresectable extrahepatic malignant biliary obstruction
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For right upper quadrant pain, characterize the pattern (acute vs chronic, post-meal vs unrelated, with vs without fever/jaundice) and triage acute red-flag presentations (Murphy sign, Charcot's triad, painless jaundice with weight loss, pregnancy with LFT/coagulation derangement) to the ED. Obtain labs (CBC, CMP with LFTs, lipase, urinalysis, pregnancy test in reproductive-age women) and RUQ ultrasound as first imaging, then direct further workup by ultrasound findings, cholecystectomy for acute cholecystitis, MRCP for suspected choledocholithiasis based on risk stratification (e.g., high-risk criteria including CBD dilation >6 mm, bilirubin >4 mg/dL, or gallstone pancreatitis), CCK-HIDA/GBEF for acalculous functional gallbladder disorder, and cross-sectional imaging for liver masses or other pathology.