Malignant biliary obstruction usually presents with painless jaundice, pruritus, and much less commonly signs and symptoms of infectious cholangitis such as fever and leukocytosis. Other features include dark urine resulting from increased bilirubin content, loss of weight and appetite, nausea, and vomiting. The diagnosis of malignant biliary obstruction combines the use of clinical evaluation, diagnostic imaging, tissue sampling, and minimally invasive options with the initial goal of identifying candidates for curative resection. The most common causes of obstruction are pancreatic adenocarcinoma and cholangiocarcinoma, and most cases are too advanced for surgical options. Interventional radiologists and gastroenterologists offer palliative options for biliary drainage such as plastic stents and catheters, bare metal stents, and covered stents. This article provides an updated review of options and outcomes for the management of malignant biliary obstruction.
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Gut and Gastroenterology 