Percutaneous transhepatic image-guided interventions for malignant biliary obstructions: Current status

A malignant biliary obstruction (MBO) occurs when there is a blockage of the bile outflow towards the duodenum due to a malignant tumour. The most common tumours that cause MBO with direct invasion of the biliary tree are pancreatic carcinoma and cholangiocarcinoma. The biliary tree may also be blocked from tumours that cause external compression, such as enlarged hilar or ampulary lymph nodes or in some cases of hepatocellular, gastric or gallbladder cancer. Surgery is the treatment of choice if the disease is at an early stage and adjacent structures are not infiltrated. Otherwise patients will receive palliative treatment for quality of life improvement. Percutaneous transhepatic image-guided biliary interventions offer a minimal invasive approach that decompresses the blocked biliary system and have an established role in the management of both operable and inoperable patients with MBO. A variety of devices and techniques have been developed for this purpose, including the use of internal and external drains, plastic, bare metallic and covered metallic stents, biopsy forceps and unilateral or bilateral, one- or two stage- approach. The purpose of this review article is to offer a global overview of the interventional radiology role in such patients and to discuss the latest developments.