Management of malignant biliary obstruction

Malignant bile duct obstruction is not uncommon, particularly in the later stages of disease, and may result in significant deterioration in the patient's quality of life, particularly if the patient becomes pruritic. Patients who have undergone previous intervention such as surgery with bilioenteric bypass, sphincterotomy, or endoscopic retrograde cholangiopancreatography may present with cholangitis. In addition, obstructive jaundice may preclude the use of certain chemotherapeutic agents either because of increased toxicity or because they require hepatic metabolism or excretion. This article discusses the indications for drainage in this patient population, technical considerations that may be unique to this patient population, and technical suggestions for performing drainage that may be helpful.