title: 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.
authors.affiliation: Department of Medical Imaging, University of Toronto, Toronto General Hospital, 585 University Ave, Toronto, ON, M5G 2N2 Canada. Chia.ho@uhn.on.ca
authors.forename: Chia Sing
authors.initials: CS
authors.lastname: Ho
authors.forename: Andrew E
authors.initials: AE
authors.lastname: Warkentin
mesh_terms: D001650:Bile Duct Neoplasms / Q000473:pathology / Q000601:surgery; D001660:Biliary Tract Diseases / Q000473:pathology / Q000601:surgery*; D018281:Cholangiocarcinoma / Q000473:pathology / Q000601:surgery; D019299:Decompression, Surgical; D004322:Drainage / Q000379:methods; D004724:Endoscopy; D019317:Evidence-Based Medicine; D006500:Hepatic Duct, Common; D006801:Humans; D041781:Jaundice, Obstructive / Q000473:pathology / Q000601:surgery*; D018285:Klatskin Tumor / Q000473:pathology / Q000601:surgery; D015607:Stents