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Nonsurgical management of obstructive jaundice in the patient with advanced cancer.

CAUSES of malignant biliary obstruction include carcinoma of the pancreas, metastasis to portal lymph nodes, bile duct carcinoma, and carcinoma of the gallbladder. Unfortunately, most patients with such obstructions have incurable disease, so the physician's skills must be directed to prolonging and improving the quality of life. Pruritus, loss of weight, lipid malabsorption, hypoprothrombinemia, and sepsis are all manifestations of biliary obstruction. Adequate drainage of the obstructed biliary system can result in reversal of nutritional deficiencies, relief of pruritus, and clearing of infection. Untreated biliary obstruction leads to progressive hepatic failure, coma, and death. Surgical Biliary Drainage Choledochojejunostomy, cholecystojejunostomy, choledochoduodenostomy, hepaticojejunostomy, and operative placement of stent tubes and catheters have been used as palliative surgical drainage procedures. Unfortunately, patients with malignant biliary obstruction often poorly tolerate surgery and recuperate slowly. The operative mortality has been reported to be 10% to 20%. 1,2 Postoperative recovery may be prolonged by pneumonia, intra-abdominal