Endoscopic assessment and management of biliary strictures

Endoscopic radiofrequency biliary ablation treatment: A comprehensive review

“…Once common causes of benign etiology, such as common bile duct (CBD) injury during cholecystectomy, chronic pancreatitis, primary sclerosing cholangitis, ischemic and non‐ischemic injury in the setting of liver transplantation, anastomotic disease after biliary tract surgery, and abdominal traumas have been ruled out, the most frequent cause of biliary strictures in Western countries is the presence of a malignant disease. Pancreatic head cancers, extrahepatic cholangiocarcinomas, gallbladder cancers, malignant hilar lymphadenopathy and hepatocellular carcinomas can all present with a biliary stricture …”

“…B ILIARY STRICTURES REPRESENT a major diagnostic and management challenge, often requiring a multidisciplinary approach involving endoscopists, surgeons, radiologists, pathologists and oncologists. Once common causes of benign etiology, such as common bile duct (CBD) injury during cholecystectomy, chronic 25 Because most of these cancers are unresectable at presentation, the goal of treatment in these patients is palliation, which includes relief of biliary obstruction. The least invasive and most cost-effective method to achieve biliary decompression is biliary stent placement, 26 which was initially done with plastic stents (PS) that were subsequently substituted by self-expandable metal stents (SEMS).…”

“…[6][7][8][9] TREATMENT OF OCCLUDED SEMS A NOTHER APPLICATION OF RFA that has been evaluated in two studies 32,33 is the possibility to ablate tissue in-growth in occluded SEMS to achieve stent patency as an alternative to the traditional stent-in-stent insertion technique. The first study by Kadayifci et al 32 compared the use of the Habib RFA endoprobe (25) versus plastic stent placement (25) in 50 patients with malignant biliary obstruction. Radiofrequency ablation was successful in 14 patients (56%), but failed in 11 in whom a plastic stent was placed.…”

Advancing the diagnostic and therapeutic role of EUS in pancreaticobiliary disease: Hopkins Lecture 2016

“…In a study of EUS/EUS-guided FNA of proximal biliary strictures,10 we found the diagnostic performance to be better than that seen with brush cytology. EUS is now an established investigation in the management of indeterminate biliary strictures11 12…”

Highlights from this issue

“…In a succinct internationally co-authored review Dawwas et al 5 point to the role of existing and emerging endoscopic techniques in the assessment and treatment of this complex problem.…”