Malignant obstructive jaundice is caused by various malignant tumors that narrow or occlude the bile ducts at different sites. Among them, cholangiocarcinoma is the main cause of malignant obstructive jaundice. For patients with malignant biliary obstruction who have lost the chance of surgery or refused surgical treatment, the previous palliative treatment mostly used surgical internal or external drainage, or even only dissection. Although external bile duct drainage can reduce yellowing, serious complications such as bile loss, electrolyte disturbance and bile duct infection can lead to death. Endoscopic retrograde biliary drainage (ERBD) is less invasive and more effective than previous surgery, and has been widely used in clinical practice for malignant biliary obstruction that cannot be radically resected by surgery. In a study conducted by Shi Xuesen et al. in China, the success rate of the first stent placement technique was 87%. The success rate of the first biliary stent placement in our group of 54 patients with malignant biliary obstruction was 88.9%. This is basically consistent with the results of similar studies in China. Yang Yong, Department of Hepatobiliary Surgery, People’s Hospital of Ningxia Hui Autonomous Region
ERBD is currently the least damaging mode of internal biliary drainage with low complication rate and good drainage. Endoscopic biliary stent placement for advanced malignant biliary obstruction can achieve the purpose of reducing yellowing, improving the quality of life and prolonging survival. The early complications after stent placement are mainly acute cholangitis, the incidence of which is generally about 10%. Prophylactic application of antibiotics can greatly reduce the early complications; in the distant stage, cholangitis and recurrence of jaundice often occur due to biliary sludge accumulation and tumor growth exceeding and entering the stent causing stent obstruction. Biliary metal stent has thick diameter (10mm), good drainage effect and long drainage time; the disadvantage is that it cannot be replaced, and tumor can grow into the stent and cause reobstruction. Biliary plastic stent is low cost and can be replaced; the disadvantage is that the diameter of the tube is small, easy to block, and the use time is short; our pioneering method of placing plastic stent inside the biliary metal stent effectively avoids the re-obstruction caused by biliary tumor growth into the stent.