Nonsurgical management of extrahepatic obstructive jaundice

Surgical decompression of extrahepatic biliary obstruction carries a significant risk of morbidity and mortality, depending on both the cause of the obstruction and the underlying medical status of the patient. Because of this risk, a number of nonsurgical therapies have been developed that offer an alternative to conventional surgical procedures. These new and still-evolving techniques, including endoscopic papillotomy, biliary stenting, balloon dilation, endoprosthesis insertion, and various T-tube manipulations, have become viable alternatives for decompressing the biliary tree in certain jaundiced patients. With the increasing use and dissemination of such procedures, primary care physicians should become aware of their availability as well as their indications and limitations.