Blood investigations showed a deranged liver function suggestive of. The biliary stricture was caused by inflammatory changes due to choledocholithiasis in 7 patients 47%, and 2 of these patients had conditions associated with a. Untreated biliary strictures can lead to complications, such as chronic cholestasis, jaundice, recurrent sepsis, and secondary biliary cirrhosis, which can have severe ramifications. Biliary strictures frequently present a challenge in terms of diagnosis, which requires a multidisciplinary approach. Oct 16, 2019 bile duct strictures may be asymptomatic but, if ignored, can cause lifethreatening complications, such as ascending cholangitis, 2, 3 liver abscess, and secondary biliary cirrhosis. Clinical findings jaundice, fever, chills, abdominal pain. Iatrogenic causes, such as cholecystectomy and orthotopic liver transplantation, are the most.
In contrast to malignant biliary obstruction, in which shortterm palliation is often the goal of therapy, benign strictures require durable repair because most patients are in otherwise good health and are expected to live for years. Most common benign biliary strictures amandable to endoscopic. Volatile organic compounds in bile can diagnose malignant. Donor age 50 years, 1 bile duct, and the presence of a bile leak postoperatively, all appear to be positively associated with biliary strictures 17. Oct 23, 2018 biliary strictures can be broadly classified as benign or malignant biliary strictures mbss. Pdf on mar 31, 2018, hyun jik lee and others published diagnosis of. Biliary strictures and recurrence after liver transplantation for primary sclerosing cholangitis. Benign biliary strictures can be difficult to manage. Pathology etiology there are numerous causes of biliary duct strictures, including 1,2. Benign biliary strictures bbss have various origins, each with a different natural history and each demonstrating a different response to treatment. Cause, classification, and clinical manifestations biliary stricture can be seen with a wide array of nonneoplastic causes.
Strictures have a range of benign causes, but can also be a result of cancer and so an ability to. Prompt diagnosis and management of these strictures are therefore recommended in spite of their benign nature. Postcholecystectomy partial biliary stricture leading to. A total of 868 patients with benign biliary strictures were included in this study. Pdf endoscopy is a widely used approach for the treatment of benign biliary strictures. A nonanastomotic stricture is defined as 1 or more focal areas of narrowing of the bile ducts proximal to a biliary anastomosis, 11, 12 and often occurs at multiple sites. Evaluation of indeterminate biliary strictures nature. Hepatolithiasis, featuring high incidence, severe symptoms, and common recurrence, poses a heavy disease burden. A narrowed bile duct makes it difficult for bile to pass to the small bowel, causing a buildup of bile. Dominant strictures in primary sclerosing cholangitis. Traditionally, biliary strictures have been considered to be indeterminate when a diagnosis cannot be made after basic laboratory workup, abdominal imaging and endoscopic retrograde cholangiopancreatography ercp with biliary sampling. Previous reports have suggested hepaticojejunostomy as the best treatment for benign biliary stenosis. Biliary stricture occurs when the bile duct the tube that takes bile from the liver to the small bowel gets smaller or narrower.
The management landscape is constantly evolving, with the development of modifiable selfexpandable metal stents and biodegradable stents. The diagnosis of biliary stricture is often delayed due to its indolent. Management of biliary strictures after liver transplantation nicolas a. In the end, no one wants to experience a bile duct stricture. Focal intrahepatic benign bile duct stricture after cholecystectomy. Brush cytology performed during ercp is the initial step in the diagnosis of biliary strictures. The most prevalent etiology of benign strictures by far is related to surgery. Reiter,9 martina sterneck,3,4 kerstin herzer,6 henrike lenzen,1. However, the diagnostic yield from conventional endoscopic retrograde cholangiopancreatography tissue sampling is modest.
Improvements in existing technologies as well as the implementation of novel. Surgical revision of biliary strictures following adult live. Original article surgical management of benign biliary. Bile duct strictures are problematic in terms of management and distinction between benign and malignant. Pdf radiofrequency and malignant biliary strictures.
Biliary strictures present a diagnostic challenge, especially when no. The diagnosis of biliary strictures can be challenging. Classification based on the principles of surgical treatment article pdf available in world journal of surgery 2510. Biliary strictures are a wellknown and common complication of both living donor liver transplant ldlt and deceased donor liver transplant ddlt and account for more than 50% of all biliary complications of liver transplant. A number of factors can cause the bile duct to become constricted, including gallstones, scar tissue, pancreatitis, tumors, and a condition known as primary sclerosing cholangitis. A novel approach with holmium laser ablation for endoscopic. A bile duct stricture is an abnormal narrowing of the common bile duct. Endoscopy has an established role in the diagnosis and therapy of biliary strictures.
A retrospective multicenter analysis tatiana hildebrand,1 nadine pannicke,3 alexander dechene,5 daniel n. With this technique, a roux loop made of healthy, tensionfree jejunum distal to the. Edwyn harrison, md dr villa is an advanced endoscopy fellow and dr harrison is a professor in the division of gastroenterology and hepatology at the mayo clinic in scottsdale, arizona. Biliary stricture can be seen with a wide array of nonneoplastic causes. Asiapacific consensus guidelines for endoscopic management of. Biliary reconstruction options for bile duct stricture in. When this happens, bile can back up into the liver, causing abdominal pain, nausea, itching, fever, chills, and jaundice.
In western countries, iatrogenic stricture is the most common benign biliary stricture and accounts for up to 80% of all benign strictures 1, 2. Longterm results of metallic stents for benign biliary strictures. Aetiology prior local surgery, pancreatitis, trauma, gallstones. Nowadays, nonsurgical managements have largely replaced reoperation as the initial treatment of anastomotic biliary strictures even though repeated interventions are required for adequate outcome. In patients with short strictures oct 16, 2019 bile duct stricture biliary stricture is an uncommon but challenging clinical condition that requires a coordinated multidisciplinary approach involving gastroenterologists, radiologists, and surgical specialists. Apr 12, 2020 biliary stricture is a term used to describe a constriction of the bile duct, a tube which carries bile from the liver and the gallbladder to the intestines. The development of biliary strictures post right lobe ldlt appears to be inherent to the operation, as the rate of biliary strictures remains static with experience 2, 47. Endoscopic management provides an opportunity to cure hepatolithiasis, but fails to properly resolve biliary stricture without additional interventional techniques.
Differential diagnosis and treatment of biliary strictures clinical. Gastroenterology report, volume 3, issue 1, 1 february 2015, pages 2231. A biliary stricture is a narrowing of the common bile duct. Benign biliary strictures were classified according to the bismuths classification with a small modification. She had a history of waxing and waning jaundice for the last 2 months. May 25, 2014 definition a biliary stricture is an abnormal narrowing of the bile duct, the tube that moves bile a substance that helps in digestion from the liver to the small intestine 4. A 40yearold woman presented with complaints of pain in the right hypochondrium and intermittent highgrade fever with chills for 3 months. Benign biliary strictures pose difficult management problems. These strictures are longer and occur less frequently and earlier than anastomotic strictures, with a mean time to stricture formation of 3 to 6 months. Endoscopic biliary dilatation and stenting is the mainstay of therapy for biliary strictures. She had undergone open cholecystectomy 15 years back. Improvements in existing technologies as well as the implementation of novel technologies and techniques have the potential to. Biliary stricture management and treatment cleveland clinic. Pdf malignant biliary strictures are usually linked to different types of tumors, mainly cholangiocarcinoma, pancreatic and hepatocellular carcinomas find, read and cite all the research.
Management endoscopic surgery with insertion of selfexpanding metal mesh stents. Biliary strictures are challenging to diagnose and manage. Abdominal examination revealed a nontender hepatomegaly. Cholecystectomy and orthotopic liver transplantation olt are the most common iatrogenic causes of benign biliary stricture. Unfortunately, most benign bile duct strictures biliary strictures are iatrogenic, resulting from operative trauma see images. Management of biliary strictures after liver transplantation.
Biliary stricture dr n surendra babu jr resident dept. Biliary strictures occur due to a variety of mechanisms including iatrogenic, inflammatory and neoplastic causes. Preoperative diagnosis of biliary strictures often presents as a challenge to clinicians. One of the most common bbs in the west is chronic pancreatitis cp and these strictures affect the distal common bile duct cbd. This is a tube that moves bile from the liver to the small intestine. Biliary strictures and recurrence after liver transplantation. Incidence and risk factors of biliary strictures after ldlt overall biliary complications remain the most common complications after ldlt, with a reported incidence of 2043%. An innovative approach towards endoscopic management of biliary stricture is required. Malignant biliary strictures and those refractory to endoscopic therapy may require surgical intervention. Endoscopic management of biliary strictures after living. Pathological effects of biliary obstruction biliary obstruction high local concentratio n of bile salts inflammatio n 6. Strictures of the bile duct are a wellrecognized compli. Bile is a substance that helps in digestion of fatty food.
Percutaneous transhepatic biliary dilatation, used in 20 patients in group 2, was successful in 93% of 14 patients with anastomotic strictures and three 50% of six patients with primary strictures p strictures. Whether from a surgical mishap, a cancer scare, or some other source of inflammation or infection, the keys to treating and preventing further bile duct strictures are good health, quick diagnoses, and quality treatment by a specialist experienced in treating bile duct strictures. Cpassociated biliary strictures normally occur in the distal. Pdf current treatment of benign biliary strictures researchgate. Strictures can be caused during surgery on nearby tissues, such as the gallbladder. Diagnostics free fulltext benign biliary strictures.