Benign Biliary Strictures: A Systematic Review on Endoscopic Treatment Options

Abstract

Benign biliary strictures can be difficult to manage. Untreated biliary strictures can lead to complications, such as chronic cholestasis, jaundice, recurrent sepsis, and secondary biliary cirrhosis, which can have severe ramifications. The management landscape is constantly evolving, with the development of modifiable self-expandable metal stents and biodegradable stents. This review critically appraises current endoscopic treatment strategies, in particular focusing on the shortfalls, such as stent migration and stricture recurrence. It also proposes a treatment algorithm based on aetiologias and the location of the strictures.

Endoscopic treatment of benign biliary stricture using different stents: a systematic review and meta-analysis.

“…Benign biliary stricture (BBS) is defined as any narrowing along the extrahepatic bile duct with less than 75% diameter of unaffected region [1]. Most cases result from the 2 leading pathogeneses: iatrogenic biliary injury and inflammation damage [2][3][4]. The condition of iatrogenic biliary injury includes open/laparoscopic cholecystectomy, duct-duct anastomosis after liver transplantation (LT), etc.…”

“…The condition of iatrogenic biliary injury includes open/laparoscopic cholecystectomy, duct-duct anastomosis after liver transplantation (LT), etc. [4][5][6][7]. Inflammation damage is mainly from chronic pancreatitis (CP) and primary sclerosing cholangitis [3,4].…”

“…[4][5][6][7]. Inflammation damage is mainly from chronic pancreatitis (CP) and primary sclerosing cholangitis [3,4]. The incidence of BBS is about 1% for open cholecystectomy, 0.23-0.42% for laparoscopic cholecystectomy, 3-46% for CP, 5-15% for deceased LT, and 28-32% for living-donor transplantation [8][9][10][11][12].…”

“…BBS may lead to elevation of serum bilirubin, impairment of liver function, and bacterial growth in the biliary tree. If BBS is not recognized in time and managed properly, these patients can suffer from even worse prognosis because of life-threatening complications such as secondary biliary cirrhosis, portal hypertension, and cholangitis [4,13]. Therefore, every patient with BBS should receive aggressive treatment to release biliary obstruction effectively.…”

“…Currently, endoscopic intervention with stent implantation has been widely adopted for the treatment of BBS (Figure 1) [4]. With accelerated development of biomedical materials, endoscopic stents are continuously evolving, which includes multiple plastic stents (MPSs), fully covered self-expanded metal stents (FCSEMSs), and biodegradable biliary stents (BDBSs), et al [4]. Among them, MPSs are the most used because of their cheap price, low technical requirements, and acceptable long-term results.…”