Palliative percutaneous drainage in malignant biliary obstruction. Part 2: Mechanisms and postprocedure management

Malignant biliary obstruction frequently is associated with pruritus, anorexia, cholangitis, or hyperbilirubinemia; this difficult complication precludes the use of antineoplastic agents that are excreted or metabolized via the liver. In patients with low biliary obstruction, endoscopic stent placement may accomplish drainage of the entire biliary tree without the need for an external device. However, patients with high bile duct obstruction most often require a percutaneous approach to drain the target ducts to maximize drainage and to avoid draining an atrophic segment or lobe. In the first in this series of two articles, the indications for biliary drainage and preprocedure evaluation in malignant biliary obstruction were discussed. This second article describes the mechanisms of percutaneous biliary drainage and postprocedure management, including consideration of possible complications.