Management of Concurrent Biliary and Duodenal Obstruction

Abstract

Concurrent biliary and duodenal obstruction (CBDO) most commonly occurs in the setting of advanced malignancy. Most commonly, patients present with biliary obstruction followed by the development of duodenal obstruction. Diagnosis before endoscopy is frequently challenging and requires incorporating clinical history, physical examination, and biochemical and radiographic findings. Generally, CBDO is associated with poor long-term survival, as it generally reflects at least locally advanced disease. Hence, the goal of management is palliation of the symptoms by alleviating the concurrent obstructions through endoscopic and radiographic approaches. CBDO can be classified into three types based on its luminal involvement proximal to, distal to, or actually involving the major papilla. Generally, the endoscopic approach is to prioritize relief of biliary obstruction wherever possible first and to subsequently address the duodenal obstruction if possible. In this chapter, we discuss the different types and approaches to CBDO.