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Review
, 12, 83-92
eCollection

Benign Biliary Strictures: Prevalence, Impact, and Management Strategies

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Review

Benign Biliary Strictures: Prevalence, Impact, and Management Strategies

Michael Xiang Ma et al. Clin Exp Gastroenterol.

Abstract

Benign biliary strictures (BBSs) may form from chronic inflammatory pancreaticobiliary pathologies, postoperative bile-duct injury, or at biliary anastomoses following liver transplantation. Treatment aims to relieve symptoms of biliary obstruction, maintain long-term drainage, and preserve liver function. Endoscopic therapy, including stricture dilatation and stenting, is effective in most cases and the first-line treatment of BBS. Radiological and surgical therapies are reserved for patients whose strictures are refractory to endoscopic interventions. Response to treatment is dependent upon the technique and accessories used, as well as stricture etiology. In this review, we discuss the various BBS etiologies and their management strategies.

Keywords: benign biliary stricture; chronic pancreatitis; endoscopic retrograde cholangiopancreatography; liver transplantation; metal stent; plastic stent; primary sclerosing cholangitis; stricture dilatation.

Conflict of interest statement

Disclosure The authors report no conflicts of interest in this work.

Figures

Figure 1
Figure 1
Percutaneous transhepatic balloon dilatation of a proximal common bile-duct stricture.
Figure 2
Figure 2
(A, B) Examples of distal common bile-duct strictures associated with chronic pancreatitis. Note: Both strictures are relatively smooth with mild upstream biliary dilatation.
Figure 3
Figure 3
Patient with IgG4 cholangiopathy and painless obstructive jaundice. Notes: (A) Shouldered extrahepatic biliary stricture on MRCP with dilatation of the proximal biliary tree. (B) Tight proximal CBD stricture on ERCP. Appearances were suspicious for malignancy; however, cytology showed benign cells only. (C) A plastic biliary stent was placed for biliary drainage and relief from jaundice. (D) Resolution of biliary stricture after a 3-month course of oral prednisolone. Abbreviations: MRCP, magnetic resonance cholangiopancreatography; CBD, common bile duct; ERCP, endoscopic retrograde cholangiopancreatography.
Figure 4
Figure 4
(A) Magnetic resonance cholangiopancreatography of anastomotic stricture at hepaticojejunostomy. (B) Colonoscopy was used to intubate the afferent limb and locate the anastomotic stricture. (C) Dilatation of anastomotic stricture using 6 mm balloon over the wire.

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