title: Preoperative biliary drainage.
abstract: The role of preoperative biliary drainage (PBD) in patients with distal or proximal biliary obstruction secondary to resectable tumors has been a matter for debate. A review of the literature using Medline, Embase and Cochrane databases was undertaken for studies evaluating routes of drainage (endoscopic or percutaneous) and stent types (plastic or metal) in patients with resectable disease. Preoperative biliary drainage is indicated for relief of symptomatic jaundice, cholangitis, patients undergoing neoadjuvant therapy or those patients where surgery may be delayed. Endoscopic methods are preferred over percutaneous methods because of lower complication rates. In patients with proximal biliary obstruction, PBD should be guided by imaging studies to aid in selective biliary cannulation for unilateral drainage in order to reduce the risk of cholangitis in undrained liver segments.
authors.affiliation: Division of Gastroenterology and Hepatology, Department of Medicine, The Johns Hopkins Medical Institutions, Baltimore, USA.
authors.forename: Payal
authors.initials: P
authors.lastname: Saxena
authors.forename: Vivek
authors.initials: V
authors.lastname: Kumbhari
authors.forename: Mohamad E L
authors.initials: ME
authors.lastname: Zein
authors.forename: Mouen A
authors.initials: MA
authors.lastname: Khashab
mesh_terms: D001661:Biliary Tract Neoplasms / Q000150:complications* / Q000628:therapy; D002779:Cholestasis / Q000209:etiology / Q000628:therapy*; D004322:Drainage / Q000379:methods*; D006801:Humans; D011300:Preoperative Care / Q000379:methods*
keywords: borderline resectable pancreatic cancer; cholangiocarcinoma; neoadjuvant therapy; pancreatic cancer; preoperative biliary drainage