Published online Aug 28, 2015. doi: 10.4254/wjh.v7.i18.2171
Peer-review started: May 5, 2015
First decision: June 25, 2015
Revised: August 9, 2015
Accepted: August 13, 2015
Article in press: August 14, 2015
Published online: August 28, 2015
Preoperative biliary drainage (PBD) was developed to improve obstructive jaundice, which affects a number of organs and physiological mechanisms in patients waiting for surgery. However, its role in patients who will undergo pancreaticoduodenectomy for biliary obstruction remains controversial. This article aims to review the current status of the use of preoperative drainage for distal biliary obstruction. Relevant articles published from 1980 to 2015 were identified by searching MEDLINE and PubMed using the keywords “PBD”, “pancreaticoduodenectomy”, and “obstructive jaundice”. Additional papers were identified by a manual search of the references from key articles. Current studies have demonstrated that PBD should not be routinely performed because of the postoperative complications. PBD should only be considered in carefully selected patients, particularly in cases where surgery had to be delayed. PBD may be needed in patients with severe jaundice, concomitant cholangitis, or severe malnutrition. The optimal method of biliary drainage has yet to be confirmed. PBD should be performed by endoscopic routes rather than by percutaneous routes to avoid metastatic tumor seeding. Endoscopic stenting or nasobiliary drainage can be selected. Although more expensive, the use of metallic stents remains a viable option to achieve effective drainage without cholangitis and reintervention.
Core tip: Because of the postoperative complications, studies have demonstrated that preoperative biliary drainage (PBD) should not be routinely performed in patients who will undergo pancreaticoduodenectomy. PBD may be selectively applied in patients with severe jaundice, cholangitis, or severe malnutrition and in those patients with a relatively long wait before surgery. PBD should be performed through endoscopic routes rather than percutaneous routes to avoid metastatic tumor seeding. Endoscopic stenting or nasobiliary drainage can be selected. Although more expensive, the use of metallic stents remains a viable option to avoid reinterventions.