Role of endoprostheses in the management of malignant biliary obstruction

Therapeutic and palliative procedures for treating biliary obstruction can be surgical, percutaneous, or endoscopic. Incurable malignancies can be palliated by each of these three approaches. None of these has an advantage in terms of longevity over the others. Choosing the procedure which offers the best quality of life for the individual patient is complex. The virulence of the underlying tumor, the anatomic location within the biliary tree, and the availability of expertise in each of the alternative methods must be considered. For the group of patients whose conditions are palliated with transhepatic biliary drainage, the choice between chronic indwelling internal-external catheter versus endoprosthesis placement involves questions of utility, patient acceptance, and the geometry of the obstructed biliary tree. Each of these must be considered before deciding on the approach which offers the best compromise of the technical preferences of the physician, the psychological preferences of the patient, and the limitations imposed by the level and number of obstructions. Research by radiologists and gastroenterologists has resulted in improved endoprosthesis function. Current research aimed at improving stability and patency promises further improvements in endoprosthesis efficacy.