Abstract
Distal biliary stricture secondary to pancreatic cancer, cholangiocarcinoma, gallbladder cancer, carcinoma of the ampulla of Vater, or metastatic disease carries a poor prognosis, mainly because of the lack of initial symptoms and advanced stage of disease. Pancreatic cancer is responsible for almost 90% of distal biliary obstruction. Each year, more than 62,000 new patients are diagnosed with pancreatic cancer. The most common symptom is painless jaundice, but patients may also present with weight loss, anorexia, epigastric pain, and back pain. Different imaging modalities, including computed tomography (CT), magnetic resonance (MRI), endoscopic retrograde cholangiopancreatography (ERCP), and endoscopic ultrasound (EUS), are used for diagnosing and staging of distal biliary strictures. In this chapter, we will review the epidemiology, natural history, clinical presentation, diagnosis, and curative and palliative treatment of distal biliary strictures.
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