Percutaneous biliary drainage catheter insertion in patients with extensive hepatic metastatic tumor burden

In patients with advanced metastatic disease of the liver, tumors located adjacent to the biliary tree can exert mass effect resulting in biliary obstruction. Decompression of malignant biliary obstruction can be crucial for preventing acute cholangitis with accompanied sepsis, symptomatic relief of hyperbilirubinemia-associated pruritus (1), and in some cases, can facilitate a patient’s access to further chemotherapy (2,3). However, this patient population may be prone to intrinsic liver dysfunction related to extensive hepatic parenchyma replacement with tumoral tissue or hepatotoxic chemotherapies, which can also result in hyperbilirubinemia (4). Thus, the actual contribution of obstruction versus intrinsic hepatic dysfunction can be difficult to ascertain