Bile duct stricture

Last revised by Henry Knipe on 5 Dec 2023

Citation, DOI, disclosures and article data

Citation:

Gaillard F, Knipe H, Bell D, et al. Bile duct stricture. Reference article, Radiopaedia.org (Accessed on 10 Dec 2023) https://doi.org/10.53347/rID-6913

DOI:

https://doi.org/10.53347/rID-6913

Permalink:

https://radiopaedia.org/articles/6913

rID:

6913

Article created:

26 Aug 2009, Frank Gaillard ◈

Disclosures:

At the time the article was created Frank Gaillard had no recorded disclosures.

View Frank Gaillard's current disclosures

Last revised:

5 Dec 2023, Henry Knipe ◉ ◈

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

Revisions:

16 times, by 13 contributors - see full revision history and disclosures

Systems:

Hepatobiliary

Synonyms:

Common bile duct stricture
CBD stricture
Biliary strictures
Common hepatic duct strictures
Common hepatic ductal stricture
Common duct stricture
Common duct strictures
Biliary ductal strictures
Biliary duct strictures
Biliary ductal stricture
Biliary duct stricture
Common hepatic duct stricture
Common hepatic ductal strictures

Bile duct strictures are problematic in terms of management and distinction between benign and malignant.

malignant
- cholangiocarcinoma
- involvement by pancreatic head adenocarcinoma
- involvement by ampulla of Vater adenocarcinoma
- involvement by gallbladder carcinoma⁴
benign
- iatrogenic strictures
  - diathermy burns
  - hemostasis clips
  - suture granuloma
  - amputation neuroma of the cystic duct
  - previous anastomosis (e.g. post liver transplant)
- primary sclerosing cholangitis
- Mirizzi syndrome
- chronic pancreatitis
- previous stone passage

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.

Carcinoembryonic antigen (CEA) and CA 19-9 are sometimes secreted by cholangiocarcinomas.

Radiographic features

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.

Stricture morphology

Benign features include ²:

smooth
tapered margins

Malignant features include:

irregular
shouldered margins
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

Associated findings include:

features of chronic pancreatitis
evidence of previous cholecystectomy
lymph node enlargement
infiltrating mass

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)