Malignant Biliary Obstruction: Distal

Abstract Distal biliary stricture secondary to pancreatic cancer or primary biliary cancer such as cholangiocarcinoma, gallbladder cancer, carcinoma of the ampulla of Vater, or metastatic disease caries poor prognosis mainly due to lack of initial symptoms and advanced stage prognosis. Every year more then 40,000 new patients are diagnosed with pancreatic cancer. Pancreatic cancer is responsible for almost 90% of distal biliary obstruction. The main symptom is painless jaundice, but patients may also present with weight loss, anorexia, epigastric pain, and back pain. Different imaging modalities are required for the differential and final diagnosis; computed tomography (CT), magnetic resonance (MRI), endoscopic retrograde cholangiopancreatography (ERCP), and endoscopic ultrasound (EUS) are few of the modalities used for diagnosing and staging in cases of distal biliary strictures. In this chapter we will review the epidemiology, natural history, clinical presentation, diagnosis, and curative and palliative treatment of distal bilary strictures.