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Abstract : The management of malignant biliary obstruction of the liver is a challenging clinical problem. Because achieving a complete cure is rare and life expectancy is usually short, palliation of symptoms is often the best option for patients with this condition. Biliary decompression can be achieved through surgical bypass or nonsurgical methods. Recent advances in therapeutic endoscopy and interventional radiology have generally replaced surgical treatment, with its high operative risks. These effective and relatively non-invasive modalities have become the standard of care for palliation of malignant obstructive jaundice. To highlight the role of percutaneous stenting in management of malignant biliary obstruction. This study was conducted in Theodor bilharz research institute (TBRI), Egypt in collaboration with radiology department in Ain Shams University. Twenty-four patients who are referred with clinically suspected and diagnosed with malignant obstructive jaundice. This study included patients from the period between from September 2019 to September 2021. The results of this study demonstrate that, in patients with malignant obstructive jaundice, initial ERCP and initial percutaneous transhepatic stenting result in similar rates of successful biliary decompression with comparable adverse event rates. Specifically, with the initial procedure, there was no difference in the procedural success, incidence of cholangitis, and other procedure related complications. The percutaneous approach for stent insertion should be considered as the initial method of palliation for patients with advanced and difficult Bismuth types III and IV HC because of its higher procedural success rate and comparable clinical outcomes.

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