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SIR 2026

Scientific Session

Interventional Oncology

Featured Abstract

Session: General IO 2

190 - Percutaneous Drainage of Malignant Biliary Obstruction Precluding Treatment: A Single Center Experience

Tuesday, April 14, 2026
3:18 PM - 3:27 PM ET
Purpose: To evaluate the efficacy of percutaneous biliary drainage to enable oncologic therapy for patients with malignant biliary obstruction.

Materials and Methods: A single center retrospective review was performed of patients who underwent percutaneous biliary drain (PBD) placement for malignant biliary obstruction precluding oncologic treatment between January 2018 and June 2024. The primary outcome was undergoing oncologic treatment (chemotherapy, radiation, surgery, or liver-directed therapy) following PBD. Demographics, diagnosis, site and degree of obstruction, number of drains placed, total number of procedures, and rates of conversion to internalization of drains were collected. Uni- and multivariate analyses were performed to identify factors associated with treatment initiation. Overall survival was evaluated.





Two hundred and thirty-four patients were included, with 116 (50%) patients receiving oncologic treatment following PBD placement. The most common primary malignancies were pancreatic (39.2%), cholangiocarcinoma (17.7%), and colon (9.1%). Most patients (64.1%) received treatment prior to PBD placement. Biliary obstruction was extrahepatic in 43.2%, hilar in 41.9%, and intrahepatic in 14.1% of patients. Moderate or severe biliary dilation was present in 54.3%. Patients underwent a mean of 3.8 ± 4 procedures (range, 1–26) related to their biliary drain; 59% were never internalized, and 22.6% of those internalized were subsequently re-externalized.

Results: Location of biliary obstruction did not significantly impact ability to receive treatment or overall survival. Intrahepatic biliary obstruction is significantly associated with receiving more biliary drains compared to hilar or extrahepatic biliary obstruction (1.6 ± 1.3 vs 1.2 ± 0.7; p < 0.005). Patients who received oncologic treatment had a lower initial bilirubin (8.4 ± 5.8 mg/dL vs 10.9 ± 7 mg/dL; p < 0.005), underwent more drain-related procedures (5.3 ± 5.1 vs 2.4 ± 1.6; p < 0.001), and had longer time to internalization (3.1 ± 4.2 vs 1.2 ± 0.7 months; p < 0.001). In multivariate analysis, internalization was independently associated with receiving treatment (p < 0.001). Mean survival was significantly longer in patients who achieved internalization (11.4 months; 95% CI, 9.3–13.7) compared to those who did not (2.8 months; 95% CI, 2.1–3.5).

Conclusion: Among patients undergoing PBD for malignant biliary obstruction precluding therapy, half ultimately received oncologic treatment. Internalization is strongly associated with treatment initiation and improved overall survival.