Malignant biliary obstruction: endoscopic approaches.

Abstract

Malignant obstruction of the biliary tree can occur at different sites; intrahepatic, perihilar, and extrahepatic. Symptoms of biliary obstruction vary significantly from patient to patient but may include right upper quadrant abdominal pain, back or shoulder pain, pruritis, jaundice, acholic stool, dark urine, and fatigue. Less than ten percent of malignancies involving the biliary tree will present with evidence of cholangitis; typical symptoms of biliary obstruction along with fever, chills, or bacteremia. A multidisciplinary team approach involving gastroenterologists, surgeons, interventional radiologists, and oncologists is often required for managing patients with malignant biliary obstruction. This chapter will focus on endoscopic approaches for alleviating biliary obstruction, either as a palliative technique for unresectable tumors or as a bridge to surgery for potentially curable tumors.