Preoperative biliary drainage in patients with obstructive jaundice by middle or distal bile duct obstruction from the viewpoints of evidences

Abstract

Preoperative biliary drainage (PBD) for obstructive jaundice by low bile duct obstruction was reviewed concerning randomized prospective control studies, meta-analyses and clinical practice guidelines in Japan, Europe and the United States. Preoperative biliary drainage is not routinely necessary in patients with obstructive jaundice in the middle or lower bile duct. PBD should be done in obstructive jaundice with cholangitis. Self-expandable metallic stent seems to be rather useful than plastic stent. In pancreatic head cancer, preoperative adjuvant therapy is frequently done and PBD is performed before preoperative adjuvant therapy. Thus, stenting method and stenting apparatus are the targets of examination hereafter. In distal bile duct cancer, preoperative adjuvant therapy is not usually done. Thus, the presence or absence of PBD, stenting method, and stenting equipment are the questions of further examination including prospective study. Most evidences concerning PBD come from foreign countries. Evidences from Japan is expected carefully considering the clinical practices.