Digestive Disease Interventions 2020; 04(03): 323-333
DOI: 10.1055/s-0040-1717085
Review Article

Multidisciplinary Approach to Malignant Biliary Obstruction

Derek Taeyoung Kim
1  Department of Radiology, Montefiore Medical Center, Bronx, New York
,
Uzma Rahman
2  Department of Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
,
Robert W. Tenney
1  Department of Radiology, Montefiore Medical Center, Bronx, New York
,
Oleandro A. Cercio Roa
3  Department of Medicine, St. Barnabas Hospital, Bronx, New York
,
Pawan Rastogi
4  Division of Gastroenterology, Department of Medicine, Montefiore Medical Center, Bronx, New York
,
Jacob Cynamon
5  Division of Vascular Interventional Radiology, Department of Radiology, Montefiore Medical Center, Bronx, New York
,
Yosef Golowa
5  Division of Vascular Interventional Radiology, Department of Radiology, Montefiore Medical Center, Bronx, New York
› Author Affiliations

Abstract

Treatment of malignant biliary obstruction (MBO) requires the coordination of multiple specialties, including oncologists, surgeons, gastroenterologists, and interventional radiologists. If the tumor is resectable, surgical candidates can usually proceed to surgery without preoperative biliary drainage. For patients who undergo biliary drainage, endoscopic retrograde cholangiopancreatography (ERCP) and percutaneous transhepatic cholangiography (PTC) combined with biliary stenting are techniques with comparable technical success and mortality, each with distinct advantages and risks. Advances in endoscopic ultrasound allow drainage in patients with challenging anatomy. There are a multitude of devices used for biliary decompression. Self-expanding metal stents (SEMS), with longer patency rates, are in most instances preferred over plastic stents for MBO, especially in patients with life expectancy more than 3 to 4 months. Advantages of covered SEMS versus uncovered SEMS remain controversial as covered stents can prevent tumor ingrowth but at the expense of potential increase in stent migrations. Extra-anatomic biliary drainage using lumen-apposing metal stents is an emerging technique which shows promise when conventional ERCP fails. It is imperative to understand these techniques when tailoring a treatment strategy. The goal of this article is to discuss a multidisciplinary approach for MBO to promote comprehensive care using case examples to highlight essential principles.



Publication History

Received: 04 June 2020

Accepted: 30 July 2020

Publication Date:
22 September 2020 (online)

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