The workload of the department has increased significantly after the holidays, and the wards are now fully occupied. In addition to the patients waiting for hospitalization, there are more patients who are hospitalized in other departments with “airport-style services”. After several weeks of work after the holidays, I was most impressed by the significant increase in the number of patients with obstructive jaundice, mostly elderly patients, and at one point more than half of the patients in the department were over 80. In view of the recent marked increase in patients with obstructive jaundice, I would like to say a few words about “obstructive jaundice”. 1, patients with obstructive jaundice refers to the jaundice as the main manifestation of the case, sometimes combined with fever, vomiting, abdominal pain and other symptoms, the main patients include malignant tumors of the bile ducts, malignant tumors of the head of the pancreas, malignant tumors of the duodenal papilla or malignant neoplastic disease secondary to the bile ducts or surrounding lymph nodes of the tissue causing pressure symptoms, of course, there are a small number of benign stenosis or stones leading to obstructive jaundice. Among them, malignant neoplastic disease is the most common. 2, the incidence of obstructive jaundice has increased significantly in recent years, and gradually had the development of aging. The average age of inpatients has increased year by year, and almost half of the cases of obstructive jaundice admitted since 2013 were over 80 years old, mostly combined with multi-system organ underlying diseases, making treatment extremely difficult. 3, obstructive jaundice according to the site of bile duct obstruction, can be divided into the hepatoportal bile duct obstruction (high obstruction) and common bile duct obstruction (mostly low obstruction) 2, generally speaking, low obstruction patients are more common. 4, for malignant neoplastic disease, surgery is still the first treatment option, through surgery can remove the lesion, to ensure that the patient tumor-free survival, supplemented by postoperative chemotherapy and radiotherapy treatment, and even radical cure. However, for patients with obstructive jaundice, regardless of the location of the obstruction caused by the malignant tumor, the scope of radical surgery is larger, taking “periampullary cancer” as an example, the surgery requires the removal of part of the bile duct, gallbladder, most of the stomach, part of the duodenum and most of the pancreas, requiring three major anastomoses: biliary-intestinal anastomosis, pancreatic-intestinal anastomosis and gastrointestinal anastomosis. In addition, a large range of lymph nodes need to be cleared at the same time, which means that the operation is extensive and traumatic, and the postoperative recovery is slow and the complication rate is large, so many patients “fail” in front of the operation. Of course, the surgical treatment of malignant tumors in the liver portal is more complex, and the surgery is more difficult and traumatic. 5, obstructive jaundice are mostly elderly patients, and most combined with a variety of underlying diseases, the difficulty of surgical treatment significantly increased, many clinicians “dare not” surgical treatment. Therefore, palliative treatment options are increasingly becoming the first choice for most patients. The most classic treatment modality is ERCP-based bile duct stenting, which of course also includes simple bile-intestinal anastomosis and PTCD (incisive transhepatic bile duct puncture and drainage) and other treatment options. 7.Endoscopic common bile duct stenting and drainage (ERBD) is the treatment of placing plastic stents or metal stents in the bile ducts guided by endoscopic guidewires, mainly to improve bile drainage, relieve bile duct obstruction and reduce jaundice, so as to prolong life and improve the quality of life. This treatment option is “non-invasive”, less invasive, faster and more effective, and brings good news to patients with obstructive jaundice who cannot tolerate surgical treatment. In general, the treatment effect of stenting for low obstruction is significantly better than that for high obstruction. This is related to the anatomical structure of the biliary system, as low obstruction is an obstruction of the common bile duct trunk, and placement of a stent can provide good drainage. Patients with low obstruction are significantly better than those with high obstruction in terms of difficulty of endoscopic treatment, success rate, effect of yellowing reduction treatment, occurrence of complications, quality of patient survival, and five-year survival rate. High obstruction affects multiple intrahepatic bile duct branches, with poor drainage, difficult operation, significantly lower success rate than high obstruction, and prone to various complications, postoperative jaundice regression and recovery of liver function often difficult to achieve the expected purpose, higher perioperative mortality, and lower long-term survival rate. 9. If high bile duct obstruction affects the 2nd level bile duct branch in the liver, the treatment effect is extremely poor. Due to the width of the common bile duct, it is difficult to place stents in each obstructed bile duct branch for drainage, and often only part of the liver can be liberated, and for the liver that cannot be drained, liver function is difficult to recover, and jaundice cannot be completely resolved. Supplementary external drainage with PTCD also often fails to achieve adequate drainage. 10, patients with high obstruction placed stents are prone to retrograde infection, and once intrahepatic restrictive cholangitis can lead to massive bacterial growth and a greater chance of combined liver abscess, and bacteria enter the blood through the liver sinusoids early, easily causing bacteremia, sepsis, leading to systemic inflammatory response syndrome, infectious shock, and even death due to severe infection is not uncommon. And the acute inflammatory reaction mostly affects the kidney at an early stage, causing acute renal impairment or even failure, which may be life-threatening. The effect of high-intensity anti-infective treatment in case of poor drainage is poor. 11.The sensitivity and effectiveness of chemotherapy and radiotherapy treatment for malignant tumors causing obstructive jaundice are significantly lower than those of other systemic malignancies. 12.For high-grade obstructive malignant tumors, PTCD is an effective complementary treatment when ERBD cannot achieve the desired effect. 13. Malignant tumors originating from pancreatic head or duodenal papilla in advanced stage all invade or compress the gastrointestinal tract causing symptoms of intestinal obstruction, which can be treated by placing intestinal stent or gastrointestinal anastomosis surgery, but the prognosis is poor. 14.For cases where ERBD fails, biliary stent can be placed through PTCD duct on a trial basis, and PTCD can be removed after success, so as to achieve the effect of effective internal drainage. 15, ERBD is an internal drainage treatment plan, bile can be drained into the intestine, which has less impact on digestive function; PTCD is an external drainage treatment plan, bile is lost, which has a greater impact on digestive function, the patient’s diet is poor, and in the long run, the body is getting worse and worse, and the tolerance to sequential treatment is getting worse.