Table 2.

Tips for optimising care in the event of PBD requirement.

Indication for PDB	Comment
Initial attempt at PBD	ERCP with self-expanding metal stent
Position of stent	The stent should be short and ideally not occlude the cystic duct origin as this can lead to cholecystitis which can delay surgery or chemotherapy
Periprocedural care	Antibiotics before and after the procedure Regular observations with escalation to medical team in event of abdominal pain and/or hypotension. Consideration of CT in event to exclude pancreatitis or perforation.
Options if initial PBD fails	Maximum of two attempts at ERCP. If unsuccessful for PTC with stent placement as a rescue option (referral to specialist centre may be optimal depending on local experience)
Definition of successful PBD	Biliary drainage is defined as successful if the serum bilirubin level decreased by 50% or more within 2 weeks after the procedure.