Background: Obstructive jaundice (OJ) is a cumbersome complication in pts with advanced digestive malignancies, and PTBD is often used to relieve symptoms and allow chemotherapy (CT) administration. Methods: From July 2008 to August 2011, a total of 71 pts with OJ due to advanced solid malignancies underwent PTBD in our institution. Baseline characteristics, procedure complications and outcome were retrospectively collected. The primary goal was to estimate overall survival (OS) after PTBD. Results: Patients’ median age was 60 years old, 52% were male, 72% had an ECOG performance status (PS) of 1-2 and 10% were in supportive care (SC). Most had metastatic disease at diagnosis (59.2%) and primary gastrointestinal tumors (biliary tract 42.3%, gastric 18.3%, colorectal 11.3%, pancreas 16.9% and 11.3% other sites). Mean hospital stay was 16.6 days (2-90), with bilirubin value decreased (BVD) in 80% of pts. The rate of cholangitis following PTBD was 66.2% and 60.6% of pts had readmissions related to procedure complications. Only 51.6% of pts not in SC were eligible for CT after PTBD. Median OS was 2.9 months (95% CI: 0.62-5.2). Prognostic factors on univariate analysis were ECOG ≤2 (13 versus 0.72 months p<0.0001); BVD (6.7 versus 0.33 months p<0.0001); CT after PTBD (13.7 versus 1.2 months p<0.0001). SC was a negative prognostic factor (0.8 versus 4.5 months p<0.0001). On the multivariate analysis, palliative CT after procedure was related to better OS (HR 0,16 CI: 0.05-0.48 p<0.001). Conclusions: Malignant OJ is a late, and often final event in cancer pts. Thorough evaluation is needed before determining pts eligibility to PTBD, due to its high complication and hospitalization rates. In the current analysis, pts with PS >2 and who are not candidates for further CT had a dismal prognosis, and should probably not be offered PTBD.