Malignant obstructive jaundice: Imaging and percutaneous intervention

iliary obstruction is a common clinical problem. Malignant obstructive jaundice is frequently caused by cholangiocarcinoma and pancreatic head adenocarcinoma, which are often inoperable at presentation and carry a dismal prognosis; less common causes include metastatic lymph nodes at the hepatic hilum and gallbladder cancer. The management of patients with a suspected malignant biliary obstruction ultimately depends on local expertise, availability, cost, and the multidisciplinary cooperation. An adequate assessment of malignant obstructive jaundice requires the use of various noninvasive imaging modalities, as ultrasound, computed tomography and magnetic resonance imaging to identify the level and the cause of the obstruction and to plan the treatment. Percutaneous intervention is an effective method of palliation in such patients, thereby improving their quality of life. It may also be an adjunct to surgical management by improving hepatic function before surgical resection or neoadjuvant therapy. This chapter reviews standards of care in terms of non-invasive diagnosis and percutaneous treatment of malignant biliary obstruction.