informed consent obtained after oral and written information
clinical data in accordance with a malignant bile duct obstruction
imaging evidence: (ultrasonography (US), computed tomography (CT) or magnetic resonance imaging (MRI) shows signs of extrahepatic malignant common bile duct obstruction
typical ERCP findings of a malignant common bile duct stenosis
proximal margin of the bile duct stenosis ≥2 cm from the hepatic confluence
bilirubin \> 50 micromol/L
radical surgery not deemed possible
You may not be if
patients with active hepatitis or other jaundice-causing hepatic diseases
informed consent not obtained or patient unable to give informed consent
patients with no understanding of English, Afrikaans or Xhosa where it is not possible to obtain informed consent
the patient is a possible candidate for surgical resection
suspicion of a non-malignant bile duct obstruction, e.g. stones or benign stenosis (should initiate further investigations)
the proximal end of the stenosis is \< 2 cm from the hepatic confluence
previous BII or Roux-en-Y gastric reconstruction
significant duodenal obstruction making ERCP difficult
