Transhepatic Biliary Intervention for Malignant Biliary Obstruction.

Malignant biliary obstruction commonly arises from cholangiocarcinoma, pancreatic cancer, ampullary cancer, or metastatic disease, leading to jaundice, cholangitis, and impaired liver function. Management centers on achieving adequate biliary drainage to improve symptoms, enable surgery or chemotherapy, and prevent sepsis. Endoscopic and percutaneous transhepatic approaches each offer distinct advantages depending on anatomy, disease extent, and patient factors. Percutaneous techniques allow targeted drainage, tissue diagnosis, and therapeutic interventions such as stenting and endobiliary ablation. Emerging percutaneous cholangioscopic methods enhance visualization and biopsy accuracy. Optimal management requires multidisciplinary decision-making informed by obstruction level, planned oncologic therapy, and overall clinical goals.