[Malignant extrahepatic bile duct occlusion. Diagnosis and palliative treatment]

A diagnosis of malignant extrahepatic biliary obstruction was made in 123 cases by endoscopic retrograde cholangio-pancreaticography (ERCP) and (or) percutaneous transhepatic cholangiography (PTC). The diagnosis was confirmed by operation, biopsy or autopsy or further investigations and follow-up. The diagnosis was correct in 96% and false in only 4%. Clinical and biochemical findings were unreliable. Ultrasound investigations were accurate in 94% of cases with malignant obstruction low down. However, it was negative in cases with high obstruction in 19% due to the absence of dilatation of the intrahepatic biliary ducts. Consequently these cases could not be diagnosed without additional ERCP and PTC. ERCP and PTC also permit palliative treatment to be done. In 30% of all cases a palliative non-surgical treatment was performed such as endoscopic sphincterotomy with or without endoprosthesis or percutaneous transhepatic drainage.