Published online Jun 15, 2016. doi: 10.4251/wjgo.v8.i6.498
Peer-review started: July 19, 2015
First decision: September 17, 2015
Revised: March 14, 2016
Accepted: April 21, 2016
Article in press: April 23, 2016
Published online: June 15, 2016
Core tip: Treatment of malignant biliary obstruction from cholangiocarcinoma or pancreatic cancer can be performed via endoscopic, percutaneous, or surgical means. The decision of when or how to achieve biliary decompression depends on the patient’s condition, location of stricture, and stage of malignancy. Not all patients require biliary decompression, particularly with resectable tumors. Self-expanding metallic stents or plastic stents may be used for distal malignancy, depending on stage and prognosis. Stents, nasobiliary drainage, or percutaneous drains may be used for hilar strictures. Endoscopic catheter-based therapies such as photodynamic therapy or radiofrequency ablation may prolong patient survival by achieving local tumor control.