BILIARY DRAINAGE IN OBSTRUCTIVE-JAUNDICE - EXPERIMENTAL AND CLINICAL ASPECTS

Jaundiced patients undergoing invasive diagnostic and therapeutic proc edures are at increased risk of complications and death. Despite the l arge number of clinical and experimental investigations carried out to identify relevant risk factors, no single parameter has been found to be consistently useful in predicting morbidity or mortality. Biliary decompression was initially employed by surgeons and subsequently by i nterventional radiologists. More recently, endoscopic retrograde chola ngiopancreatography has provided an alternative route for decompressio n of the biliary tree and preliminary data using this method are encou raging. Although there are enthusiastic proponents of various therapeu tic techniques, controlled trials have not been convincing in highligh ting the benefits of biliary drainage or in determining the best appro ach. This article reviews the literature pertaining to this complex su rgical problem; an attempt has been made to balance the advantages and disadvantages of biliary decompression as palliation and/or prelimina ry treatment for extrahepatic biliary obstruction.