Management of Malignant Distal Biliary Obstruction

Publication date: Available online 11 February 2015 Source:Gastrointestinal Intervention Author(s): Lisa Cassani , Jeffrey H. Lee The most common cause of malignant distal biliary obstruction is pancreatic cancer, as 70% to 90% of patients will develop jaundice during the course of their disease. Pancreatic cancer is usually advanced at presentation, and curative resection is possible in less than 15% of patients. If a patient is to undergo early surgical resection, biliary drainage is not prerequisite. Early surgery without preoperative biliary drainage did not increase the risk of complications, as compared with preoperative biliary drainage, followed by surgery. Post-operative complications did not differ significantly between the two approaches. In light of no significant improvements in patient survival in large trials of a surgery-first followed by adjuvant therapy over the last 2 decades, there has been a paradigm shift to move towards preoperative neoadjuvant chemotherapy in the setting of borderline resectable disease. Consequently, effective preoperative biliary drainage has become a paramount concern in this setting. Multiple retrospective and prospective studies have compared the outcomes between covered metal stents and uncovered metal stents in malignant biliary obstruction. In patients undergoing neoadjuvant chemoradiation or surgical resection, no significant self expanding metal stent (SEMS)-related complications or adverse events were seen. Additionall...
Source: Gastrointestinal Intervention - Category: Gastroenterology Source Type: research