Bile duct stricture
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At the time the article was created Frank Gaillard had no recorded disclosures.View Frank Gaillard's current disclosures
At the time the article was last revised Henry Knipe had the following disclosures:
- Integral Diagnostics, Shareholder (ongoing)
- Micro-X Ltd, Shareholder (ongoing)
These were assessed during peer review and were determined to not be relevant to the changes that were made.View Henry Knipe's current disclosures
Bile duct strictures are problematic in terms of management and distinction between benign and malignant.
There are numerous causes of biliary duct strictures, including 1,2:
Although identification of malignant cells on washings obtained during ERCP can make the diagnosis, they are negative in 25-50% of cases 1. Careful imaging is therefore often required.
The distinction between malignant and benign structures relies on two aspects:
morphology of the stricture
associated findings, pointing to a cause
As far as assessing the morphology of the stricture, modalities that image the lumen (ERCP, MRCP, CT intravenous cholangiograms) are best, whereas to assess for associated features US or CT/MRI are better.
Benign features include 2:
Malignant features include:
thickened (>1.5 mm) and enhancing (on arterial and or portal venous phase) duct walls 2
It is often difficult to distinguish between malignant and benign strictures, especially if short 2.
Associated findings include:
features of chronic pancreatitis
evidence of previous cholecystectomy
lymph node enlargement
Treatment and prognosis
Treatment and prognosis clearly depend on the underlying etiology.
For benign stricture, a number of treatment options exist, including:
cholangioplasty: percutaneous or retrograde balloon dilation 3
stent placement: only considered in failed cholangioplasty when no other surgical options
surgery with resection of the stenotic segment and re-anastomosis or choledochoenterostomy (e.g. Roux-en-Y)
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- 2. Choi S, Han J, Lee J et al. Differentiating Malignant from Benign Common Bile Duct Stricture with Multiphasic Helical CT. Radiology. 2005;236(1):178-83. doi:10.1148/radiol.2361040792 - Pubmed
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