Malignant tumors cause the vast majority of biliary obstructions. While obstruction primarily occurs in late-stage disease, it is unfortunately the presenting symptoms for many gastrointestinal tract cancers. Biliary obstruction can be life-threatening leading to sepsis and death and, therefore, relieving this obstruction rapidly and durably is critical. Interventions to restore biliary flow through stenting or external drainage can decrease serum bilirubin levels, relieve symptoms, and improve quality of life through symptomatic relief while facilitating further medical and surgical therapies to treat the patient’s underlying malignancy. The management of these complex and debilitating conditions requires a multidisciplinary medical, surgical, and interventional approach. Interventional radiologists and gastroenterologists use diagnostic imaging, and image-guided percutaneous and endoscopic methods for both treatment and symptomatic palliation.