Malignant obstructive jaundice can be caused by many malignant diseases, such as: bile duct cancer, pancreatic cancer, metastatic cancer, duodenal papillary cancer, pot belly cancer, gallbladder cancer, etc., which can lead to poor or obstructed bile drainage, increased pressure in the bile duct, and bile stasis. It can cause apoptosis and necrosis of hepatocytes and impaired liver function; bile stasis can also be secondary to Gram-negative intestinal bacillus infection and cause recurrent cholangitis; the inability of bile to enter the digestive tract can produce digestive and absorption dysfunction on the one hand, and on the other hand, due to malabsorption of fat-soluble vitamins, vitamin K, A, D, E and other deficiencies, resulting in a series of symptoms. Due to the reduction of bile acid salts in the intestinal tract, its role in inhibiting the growth of Gram-negative bacteria is weakened, which can lead to an increase in endotoxin into the blood, and the increase in endotoxin can damage kidney function. The incidence of pancreaticobiliary tumor has been increasing in recent years, and most of the patients with pancreaticobiliary tumor are in the middle and late stage when they are diagnosed, and the surgical resection rate is less than 20%, so timely removal of biliary obstruction is the key to treatment. Stenting can not only improve the liver function damage caused by bile stagnation, but also relieve the pressure of bile duct and improve the blood flow to the liver, which can enhance the liver metabolism and gradually reduce the concentration of bilirubin to improve the liver function. Both stenting and endobiliary drainage can successfully relieve bile duct obstruction and maintain patency for a longer period of time, and there is no significant difference in the effect of yellowing reduction and its speed and survival time, but the stenting group is significantly better than the endobiliary drainage group in terms of survival quality. Transduodenoscopic (ERCP) route. The bile duct was first selectively intubated, and after the guidewire crossed the obstructed segment, an appropriate amount of 30% pantothenic glucosamine was injected to understand the site, degree and length of bile duct stenosis, and the guidewire was superselected to the most significantly dilated bile duct with the widest drainage range. A metal stent is then inserted with a pushing device via a guidewire. Percutaneous transhepatic puncture (PTCD) route. In the supine position with routine preparation, the bile is confirmed to be in the bile duct by imaging or aspirating, and then a guide wire is introduced into the intrahepatic bile duct, the guide wire and catheter are exchanged, and the chest wall path is dilated with a dilating sheath. The combined ERCP and PTCD route is performed in the left prone position, and after conventional percutaneous transhepatic percutaneous contrast, the guidewire is super-selected and introduced into the descending duodenal segment through the stenosis via the duodenal papilla, and then the duodenoscope is inserted for examination, and the following operation is performed through the endoscopic biopsy orifice: the contrast tube is inserted, and the guide wire at the papillary opening is docked with the catheter-guide wire pair kissing method, and the dilated bile duct is inserted across the stenosis. The contrast tube was guided by the guidewire into the bile duct, a new guidewire was inserted through the contrast tube, the bile duct branch was superselected, endoscopic bile duct metal stent drainage was performed, and the punctured guidewire and catheter were withdrawn. The metal stent placement via ERCP route has been widely used for the treatment of malignant bile duct obstruction because of its low trauma, high success rate, wide applicability and repeatability. It was found that both endoscopic stenting and endobiliary drainage could successfully relieve bile duct obstruction and maintain patency for a longer period of time, with no statistically significant difference in the effect of yellowing reduction, its speed and survival time. In contrast, they were significantly better than the latter in terms of complications, morbidity and mortality rates and postoperative hospital days, and were higher than the surgical group only in terms of the retreatment rate of stent obstruction. With the proficiency and improvement of operation techniques, such as flexible application of guidewire, the success rate of operation can be further improved and the occurrence of complications can be reduced. Endoscopic biliary drainage has a wider range of indications than open surgery and is usually not restricted by age. Patients with a small amount of ascites and changes in liver function combined with a mild decrease in coagulation can still be performed with caution, but cases with severe cardiac, pulmonary, hepatic, or renal dysfunction, gastrointestinal obstruction, or previous upper gastrointestinal surgery such as total gastrectomy should be considered contraindicated. However, there are still some problems that need to be solved: during PTCD surgery, in some patients, if the obstruction is serious, the stent opening is small and cannot drain smoothly, or the larger vessels are damaged by intraoperative puncture, external drainage tubes need to be left in place to prevent bleeding, bile leakage, biliary peritonitis, etc., which brings inconvenience to life. The external drainage can cause loss of bile and cause water and electrolyte disorders and lack of digestive enzymes, which affects digestion and absorption; the stent is placed under fluoroscopy, which sometimes causes inaccurate positioning. Patients who choose this procedure are mostly those with severely impaired liver function, gastrointestinal obstruction, previous upper gastrointestinal surgery such as total gastrectomy, or those with combined cardiopulmonary or other systemic diseases who are not suitable for or cannot tolerate ERCP operation. Combined ERCP and PTCD route has the advantages of less trauma, higher success rate and better safety. This method can be used as the preferred palliative treatment after ERCP failure, which is suitable for stenting by ERCP route. Although there are multiple routes for biliary stent placement, each route has its own advantages and disadvantages. Clinicians should select a reasonable route for treatment after detailed evaluation of the patient’s systemic and local conditions, and should not overemphasize a certain placement method in order to improve the safety and effectiveness of biliary stenting in clinical application, increase the success rate and reduce the occurrence of complications as much as possible.