Endoscopic therapy of benign biliary strictures

Abstract

Benign biliary strictures are being increasingly treated with endoscopic techniques. The benign nature of the stricture should be first confirmed in order to ensure appropriate therapy. Surgery has been the traditional treatment, but there is increasing desire for minimally invasive endoscopic therapy. At present, endoscopy has become the first line approach for the therapy of postliver transplant anastomotic strictures and distal (Bismuth Ⅰand Ⅱ) post-operative strictures. Strictures related to chronic pancreatitis have proven more difficult to treat, and endoscopic therapy is reserved for patients who are not surgical candidates. The preferred endoscopic approach is aggressive treatment with gradual dilation of the stricture and insertion of multiple plastic stents. The use of uncovered self expandable metal stents should be discouraged due to poor long-term results. Treatment with covered metal stents or bioabsorbable stents warrants further evaluation. This area of therapeutic endoscopy provides an ongoing opportunity for fresh research and innovation.

The role of percutaneous transhepatic biliary drainage in the management of massive blunt liver trauma: Report of a case

“…Direct bile duct trauma, thermal injury as a result of over-cauterization, ischemia of the bile duct secondary to vascular injury, and incorrectly placed vascular clips may cause stricture during such major surgical operations. [2,[5][6][7][8] The selective non-operative management of blunt liver trauma has become the standard of care. However, hemodynamic stability and no signs of peritonitis are absolute requirements in the non-operative management.…”

Endoscopic treatment of biliary complications after liver transplantation

“…Finally, in the LRLTx group we observed 17 patients in whom the ERCP failed (38.6%): 15 were treated with [11] . The use of fully covered metal stents (removable) for leaks and strictures has not been tested yet, so further prospective studies are necessary in order to establish whether these new devices could improve the current results.…”

Benign bile duct strictures

“…Percutaneous treatment by balloon dilatation followed by short-to intermediate-term stent placement appears to provide a more durable result. 14 The role of metallic stents in this situation needs further evaluation. 15 …”