Background: Treatment options for palliating obstructive jaundice in patients with unresectable cholangiocarcinoma (CCA) and gallbladder cancer (GBC) include endoscopic, percutaneous, and operative stenting. This study compares the outcomes of these three therapies used for the palliation of jaundice in patients with unresectable biliary malignancies. Methods: All patients with unresectable CCA or GBC at two academic medical centers between January 1998 and December 2001 were reviewed retrospectively. Collected data included: clinical and pathologic diagnosis, mode of palliation, number of biliary stents, number of palliative procedures, and survival. Chi square and Kaplan-Meier tests were performed as appropriate. P value of less than 0.05 was considered statistically significant.Results: A total of 80 patients (51% female) were identified with a mean age of 65.1±12.8 years. All patients were followed till death. Diagnosis categories were: intrahepatic CCA (n=11), hilar CCA (n=44), distal CCA (n=12), and GBC (n=13). Data for number of stents, total stent procedures, and survival for the three palliative therapies are shown in the table (data are expressed as the mean ± S.E.M.). Conclusions: For patients with unresectable bile duct cancer, endoscopic, percutaneous, and operative stenting procedures appear to be comparable in palliating obstructive jaundice. Appropriate therapy should be selected on the basis of level of biliary obstruction, patient quality of life, and treatment center expertise.

				Survival
Palliation	N	Tot Stents	Stent Proc	One year (%)	Median (months)
Endoscopic	22	4.3±0.8	3.2±0.5	36	11
Percutaneous	25	6.4±1.2	5.0±1.1	17	13
Surgical	22	4.2±0.7	2.2±0.4	23	11
None	11	-	-	27	6