Nonoperative management of malignant biliary obstruction: a radiologic alternative

Twelve patients with advanced malignant biliary obstruction were managed with a combination of sonography, percutaneous fine-needle aspiration biopsy, transhepatic cholangiography, and percutaneous biliary drainage. Excellent palliation of biliary obstruction was obtained in nine patients, four of whom are still living. Surgery was avoided in all cases, and a single episode of sepsis was the only complication. The literature indicates that surgical bypass procedures for malignant bile duct obstruction incur an average 20% operative mortality and provide only a 6 month mean survival. A combined radiologic approach offers an alternative to standard operative management of malignant biliary obstruction. When the cost-benefit ratios of operative vs. nonoperative management are considered, perhaps more patients should undergo radiologic management.