Review
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Mar 14, 2022; 28(10): 985-1008
Published online Mar 14, 2022. doi: 10.3748/wjg.v28.i10.985
Malignant biliary obstruction due to metastatic non-hepato-pancreato-biliary cancer
Takeshi Okamoto
Takeshi Okamoto, Department of Gastroenterology, St. Luke’s International Hospital, Chuo-ku 104-8560, Tokyo, Japan
Author contributions: Okamoto T wrote the manuscript.
Conflict-of-interest statement: The author has no financial disclosures or conflicts of interest to declare.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Takeshi Okamoto, MD, Staff Physician, Department of Gastroenterology, St. Luke’s International Hospital, 9-1 Akashicho, Chuo-ku 104-8560, Tokyo, Japan. tak@afia.jp
Received: March 20, 2021
Peer-review started: March 20, 2021
First decision: July 3, 2021
Revised: July 3, 2021
Accepted: February 15, 2022
Article in press: February 15, 2022
Published online: March 14, 2022
Abstract

Malignant biliary obstruction generally results from primary malignancies of the pancreatic head, bile duct, gallbladder, liver, and ampulla of Vater. Metastatic lesions from other primaries to these organs or nearby lymph nodes are rarer causes of biliary obstruction. The most common primaries include renal cancer, lung cancer, gastric cancer, colorectal cancer, breast cancer, lymphoma, and melanoma. They may be difficult to differentiate from primary hepato-pancreato-biliary cancer based on imaging studies, or even on biopsy. There is also no consensus on the optimal method of treatment, including the feasibility and effectiveness of endoscopic intervention or surgery. A thorough review of the literature on pancreato-biliary metastases and malignant biliary obstruction due to metastatic non-hepato-pancreato-biliary cancer is presented. The diagnostic modality and clinical characteristics may differ significantly depending on the type of primary cancer. Different primaries also cause malignant biliary obstruction in different ways, including direct invasion, pancreatic or biliary metastasis, hilar lymph node metastasis, liver metastasis, and peritoneal carcinomatosis. Metastasectomy may hold promise for some types of pancreato-biliary metastases. This review aims to elucidate the current knowledge in this area, which has received sparse attention in the past. The aging population, advances in diagnostic imaging, and improved treatment options may lead to an increase in these rare occurrences going forward.

Keywords: Bile duct obstruction, Obstructive jaundice, Pancreas, Metastasis, Endoscopic retrograde cholangiopancreatography

Core Tip: Metastases from distant primary cancers are rare causes of biliary obstruction. The most common primaries include renal cancer, lung cancer, gastric cancer, colorectal cancer, breast cancer, lymphoma, and melanoma. Clinical presentation, appropriate immunohistochemical markers for pathological analysis, treatment options, and prognosis may differ depending on the primary cancer. A review of the existing literature and characteristics of metastases from each primary are presented.