title: ACR Appropriateness Criteria radiologic management of benign and malignant biliary obstruction.
abstract: The optimal treatment for patients with biliary obstruction varies depending on the underlying cause of the obstruction, the clinical condition of the patient, and anticipated long-term effects of the procedure performed. Endoscopic and image-guided procedures are usually the initial procedures performed for biliary obstructions. Various options are available for both the radiologist and endoscopist, and each should be considered for any individual patient with biliary obstruction. This article provides an overview of the current status of radiologic procedures performed in the setting of biliary obstruction and describes multiple clinical scenarios that may be treated by radiologic or other methods. The ACR Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed every 2 years by a multidisciplinary expert panel. The guideline development and review include an extensive analysis of current medical literature from peer-reviewed journals and the application of a well-established consensus methodology (modified Delphi) to rate the appropriateness of imaging and treatment procedures by the panel. In those instances in which evidence is lacking or not definitive, expert opinion may be used to recommend imaging or treatment.
authors.affiliation: University of Colorado, Anschutz Medical Campus, Aurora, Colorado, USA. Charles.Ray@ucdenver.edu
authors.forename: Charles E
authors.initials: CE
authors.lastname: Ray
authors.forename: Jonathan M
authors.initials: JM
authors.lastname: Lorenz
authors.forename: Charles T
authors.initials: CT
authors.lastname: Burke
authors.forename: Michael D
authors.initials: MD
authors.lastname: Darcy
authors.forename: Nicholas
authors.initials: N
authors.lastname: Fidelman
authors.forename: Frederick L
authors.initials: FL
authors.lastname: Greene
authors.forename: Eric J
authors.initials: EJ
authors.lastname: Hohenwalter
authors.forename: Thomas B
authors.initials: TB
authors.lastname: Kinney
authors.forename: Kenneth J
authors.initials: KJ
authors.lastname: Kolbeck
authors.forename: Jon K
authors.initials: JK
authors.lastname: Kostelic
authors.forename: Brian E
authors.initials: BE
authors.lastname: Kouri
authors.forename: Ajit V
authors.initials: AV
authors.lastname: Nair
authors.forename: Charles A
authors.initials: CA
authors.lastname: Owens
authors.forename: Paul J
authors.initials: PJ
authors.lastname: Rochon
authors.forename: Don C
authors.initials: DC
authors.lastname: Rockey
authors.forename: George
authors.initials: G
authors.lastname: Vatakencherry
mesh_terms: D001650:Bile Duct Neoplasms / Q000175:diagnosis* / Q000628:therapy*; D002779:Cholestasis / Q000175:diagnosis* / Q000628:therapy*; D019299:Decompression, Surgical; D003952:Diagnostic Imaging / Q000592:standards*; D004322:Drainage; D016145:Endoscopy, Digestive System; D019317:Evidence-Based Medicine / Q000592:standards; D006801:Humans; D015642:Radiology, Interventional / Q000592:standards; D015607:Stents
keywords: Appropriateness criteria; benign biliary obstruction; endoscopy; interventional radiology; malignant biliary obstruction; radiology