Is PTBD the initial method to treat biliary obstruction

Is percutaneous transhepatic biliary drainage (PTBD) the most appropriate initial method to treat biliary obstruction? 

The selection of the most appropriate modality (percutaneous, endoscopic, or surgical) to provide biliary drainage depends on the interventional options available, the location and extent of the obstructing lesion, and the expertise of the operator.

Currently, endoscopic drainage is the initial procedure of choice for biliary decompression, because of its reported lower complications and better patient tolerance compared with the transhepatic approach.

However, not all endoscopic drainages are successful, and PTBD continues to play an important role in the management of biliary disease. Biliary disease is best managed by a team that includes an endoscopist, interventional radiologist, and surgeon.

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