Endoscopic Palliation of Malignant Biliary Obstruction

Endoscopic retrograde cholangiopancreatography (ERCP) has become the treatment of choice for palliation of malignant biliary obstruction, with lower morbidity and improved quality of life over surgical bypass, and a lower complication rate than percutaneous transhepatic cholangiography (PTC). Endoscopic palliation of biliary malignancies is an evolving arena. The interventional endoscopist has a choice of polyethylene stents of various configurations and uncovered, partially covered, or fully covered metal stents. The precise applications and patient selection for each of these stents is still a matter of considerable research and debate. In a minority of patients, when access to the biliary tree fails, either on account of duodenal obstruction, inability to cannulate the bile duct or inability to traverse a complex biliary stricture at ERCP, endoscopic ultrasound-guided cholangiopancreatography (EUSCP) provides a safe and effective alternative in experienced centers. This review discusses the anatomical considerations, techniques, efficacy, safety, and some cost issues pertaining to endocopic palliation of malignant biliary strictures.