In the endoscopic management of obstructive jaundice due to a distal CBD stricture from periampullary carcinoma, the preferred palliative biliary drainage procedure is:

• A Percutaneous transhepatic biliary drainage (PTBD) as first-line for all CBD strictures
• B Open surgical choledochoduodenostomy as primary palliation
• C ERCP with placement of a self-expanding metal stent (SEMS) for unresectable disease ✓
• D Conservative management with ursodeoxycholic acid

Explanation

For malignant distal CBD obstruction in unresectable disease, ERCP with placement of a self-expanding metal stent (SEMS) is the preferred palliative biliary drainage technique. SEMS have larger lumens than plastic stents (10 Fr), lower occlusion rates, and longer patency (median ~6 months) with fewer reinterventions, making them preferable for expected survival >3 months. Covered SEMS are increasingly used in resectable disease to allow neoadjuvant chemotherapy. PTBD is reserved for failed ERCP or post-gastrectomy anatomy. Choledochoduodenostomy is used surgically when ERCP is not feasible or at time of exploratory surgery.

Reference: Bailey & Love's Short Practice of Surgery, 27th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.