Different response to preliminary biliary drainage in proximal versus distal malignant biliary obstruction

This study assessed prospectively the results of endoscopic biliary drainage preoperatively in 40 patients with extrahepatic malignant biliary obstruction. The patients were divided into two groups depending upon the location of the obstruction. Those in group 1, n = 20, were patients with proximal malignant obstruction and those in group 2, n = 20, had distal malignant biliary obstruction. Preliminary endoscopic biliary drainage succeeded in lowering the biliary pressure and the incidence of bacteremia in patients in group 2. In contrast, for those in group 1, it failed to reduce the intrabiliary pressure and, thus, in the presence of bile infection led to an increased incidence of bacteremia. From the results of the present study, preliminary endoscopic biliary drainage is recommended for patients with distal malignant biliary obstruction. For those with proximal malignant biliary obstruction, surgical drainage appears to be the method of choice.