Radiologic approach to malignant biliary obstruction: review and commentary.

Access to the biliary tree for nonoperative intervention can be achieved endoscopically or by a direct transhepatic approach. If there is a surgical drainage tube in place this may also serve as a route for catheter insertion. Once within the ductal system, catheters can routinely be manipulated through obstructing lesions to provide biliary decompression and relieve jaundice and cholangitis. Permanent palliation can be achieved utilizing totally indwelling endoprosthesis to avoid the problems associated with external drainage catheters. The optimal management of patients with malignant biliary obstruction requires close cooperation between endoscopists and interventional radiologists.