The radiological management of malignant biliary obstruction

Percutaneous transhepatic biliary drainage has become widely accepted as a safe and effective palliative therapy for malignant biliary obstruction. The results of drainage were reviewed over a 3-year period and patients divided by the response to decompression as measured by change in serum bilirubin. Patients with good response survived an average of 198 days, while patients with a poor response survived an average of 12 days. No procedural mortality was encountered. However, despite the generally good results, a 30-day mortality rate of 28% was seen, with good responders having a mortality of 10% and poor responders a mortality of 88%. Patients with hepatic metastatic disease as documented by liver-spleen scan, ultrasonography or computed tomography do poorly, surviving an average of 39 days, despite a good biochemical response. The success of percutaneous biliary decompression has allowed surgeons to select cases for cholecystenterostomy from the group of good responders. A more selective clinical approach is suggested for radiologists on the basis of these results.