Malignant Biliary Obstruction

Malignant causes of biliary obstruction are often difficult to treat, as these cancers frequently present at late stages. Fortunately, there are now many diagnostic and therapeutic interventional and endoscopic techniques used to facilitate accurate diagnosis and treatment. Diagnostic strategies range from non-invasive imaging to endoscopic fluoroscopy and ultrasound to facilitate biopsy, as well as direct visualization through cholangioscopy. Therapeutic options include biliary stricture dilation, stenting, and drainage both for symptomatic/palliative management and to optimize patients for further medical and surgical management. Management of these patients are best served by a multidisciplinary approach. This chapter will review the currently available techniques for diagnosing and treating malignant biliary obstruction as well as the issues related to clinical management of these complicated patients.