Background: Neoplasms of the bilio-pancreatic tract are often disgnosed in an advanced stage. Palliation of these patients is focused on resolution of biliary obstruction.
Methods: From 1 January 2003 to 31 January 2009 we managed 39 patients with a palliative procedure, 8 of them were treated by a surgical by-pass, the endoscopic procedures were 21, while the transepatic percutaneous drainages were 12.
Discussion: Surgical palliation is reserved for patients with a good performance status and expected survival of over 6 mounths, it is also indicated for whom, affected by pancreatic carcinoma, developed duodenal obstruction associated to jaundice. If the biliary obstruction is near the papillary region the treatment of choice is endoscopic drainage, if the obstruction is distal these region the way of choice is the transepatic one. Metallic stents have a greater initial cost but a less risk of obstruction than the plastic stents, these are indicated in patients with a short survival expectance.
Conclusions: Endoscopic drainage is the gold standard of treatment for obstructive jaundice, percutaneous biliary decompressione is the treatment of choice for palliation of distal bile obstruction.
