Percutaneous palliation of unresectable pancreatic cancer.

Percutaneous biliary drainage is one of several methods of palliating patients with unresectable carcinoma of the pancreas. In most cases, patients with unresectable carcinoma of the pancreas causing biliary obstruction are optimally managed by endoscopic stent placement. Percutaneous biliary drainage may be performed when endoscopic biliary drainage is unsuccessful or with obstruction at or above the hepatic duct bifurcation. Patients with common bile duct obstruction today are optimally managed by placement of expandable metal endoprostheses. In such patients with short life expectancies, symptoms of jaundice can be effectively palliated with a low rate of recurrence and with a complication rate no higher than that associated with percutaneous biliary drainage. Metal endoprostheses are associated with less pain during placement than are plastic endoprostheses and may have a lower rate of recurrence of jaundice than plastic endoprostheses in patients with common bile duct obstruction due to carcinoma of the pancreas. Patients with hilar biliary obstruction are better treated with internal-external biliary drainage catheters.