The mortality rates of surgery and percutaneous transhcpatic biliary drainage (PTHRD) are comparable. Long tenn studies show th.u delayed compltcauons (X:cur in the majority of cases of PTI IBD and surviv,tl is not improved compared to surgery. The many recent advances 111 endnscop1c ancl percutaneous drainage techniques and the recognition that the patient is best served by a noncompetitive multidisciplinary approach will ensure that virtually every patient obtains the most satisfactory drainage possible with a mirnmum of risk and discomfort. Endo:.copic drainage should be the first therapeutic option, with radiologic assistance 111 the 15 ro 25% where endoscopic drainage fails orb incomplete. Can J Gastroenterol l 990;4(9):579-587