Evidence-based decompression in malignant biliary obstruction

Abstract

As recent advances in chemotherapy and surgical treatment have improved outcomes in patients with biliary cancers, the search for an optimal strategy for relief of their obstructive jaundice has become even more important. Without satisfactory relief of biliary obstruction, many patients would be ineligible for treatment. We review all prospective randomized trials and recent retrospective non-randomized studies for evidence that would support such a strategy. For distal malignant biliary obstruction, an optimal strategy would be insertion of metallic stents either endoscopically or percutaneously. Evidence shows that a metallic stent inserted percutaneously has better outcomes than plastic stents inserted endoscopically. For malignant hilar obstruction, percutaneous biliary drainage with or without metallic stents is preferred.

Keywords: Cholangiocarcinoma, Klatskin tumor; Evidence-based medicine; Malignant biliary obstruction; Percutaneous, endoscopic, biliary drainage.

Fig. 1

Low profile fixation device for transfixing internal / external biliary drainage catheter at skin surface.

Fig. 2

Patient with internal/external biliary drainage for palliation of obstructive jaundice. External portion of catheter has been transfixed by low profile device and cut short to 3 mm above skin level. Photo showing device covered by dressings and transparent adhesive tape (Reproduced with permission from AJR).