Percutaneous biliary interventions and complications in malignant bile duct obstruction

Malignant bile duct obstruction can be a challenging clinical problem for patients and physicians alike. Indications for intervention include pruritus, cholangitis, lowering bilirubin pre-operatively or to allow for administration of some chemotherapeutic agents, and to divert bile from a post-operative leak. Low biliary obstruction, obstruction below the common hepatic duct, is usually straightforward and is often treated endoscopically. High bile duct obstruction is more complicated because it often involves isolation of ductal segments. In this paper, we will review indications, complications and outcomes of percutaneous biliary intervention and discuss technical considerations when performing biliary drainage.