ABSTRACT
Endoscopy has limitations, causes complications, and may not always be appropriate. The approach to malignant biliary obstruction is one that requires a close cooperation between gastroenterologist, radiologist, surgeon, pathologist and oncologist if the best results are to be achieved. The catheter can be reinserted over the brush and the latter withdrawn all the way to get specimens before reinserting the guidewire to commence stenting operations. One of the problems is that the brush wire is flimsy, kinks easily, and cannot be pushed through tough strictures. Computed axial tomography scanning is the most useful single imaging technique for staging malignancies causing biliary obstruction, especially when used with intravenous contrast. The technique has been described as a downward, sweeping movement of the needle from longitudinal fold to papilla and also as an upwards cut, starting at the papillary orifice, using low power, cutting current, until biliary mucosa is revealed.
