Drainage and Bypass Procedures for Palliation of Malignant Diseases of the Upper Gastrointestinal Tract

Malignant diseases of the upper gastrointestinal tract are common and often diagnosed at a point when the opportunity for curative surgical resection has passed. Symptoms of luminal obstruction include nausea, vomiting, weight loss, pain, pruritis and jaundice. The median survival of patients who cannot be cured surgically is extremely short, with a duration of only a few months. Effective palliative techniques with a low morbidity and associated mortality are required. The length of hospital stay, rapid recovery and reduction in recurrent symptoms are important factors for patients and doctors to consider when planning treatment. Traditionally, surgical techniques were used, but in the last 20 years the availability of both endoscopic and interventional radiological procedures has increased. Furthermore, advances in technology such as the development of self-expanding metal stents and covered stent designs have provided more therapeutic options for the endoscopist and radiologist. Here we discuss the available treatments for the palliation of gastric outlet and biliary tract obstruction and the evidence for the respective approaches.