Management of benign biliary strictures: current status and perspective

Abstract

Benign biliary strictures are common and occur either from hepato-biliary surgery or from diseases including chronic pancreatitis and primary sclerosing cholangitis, among others. The treatment of many such strictures is endoscopic with evolving new approaches especially with fully covered metal stents. The only classification system available is for postoperative strictures with the intention to guide surgical correction. There is no useful classification system to guide both assessment and management of benign biliary strictures. This proposed classification is relevant to patient care in assisting diagnosis and endoscopic management.

Efficacy of multiple biliary stenting for refractory benign biliary strictures due to chronic calcifying pancreatitis

“…BBS formation is a common complication from either hepato-biliary surgery or diseases, such as CP and primary sclerosing cholangitis, among others[17]. BBS complicates the course of CP in 3% to 23% of patients[18].…”

Benign Biliary Strictures: A Systematic Review on Endoscopic Treatment Options

“…Whilst the Bismuth classification for malignant biliary strictures can assist with clinical decisions, the equivalent classification for BBS has limited applicability to endoscopic interventions [19]. We refer to our classification reported in 2015 [4], where we divide BBS into four types of strictures, which has corresponding treatment modalities (Table 1).…”

“…However, there is a possibility of stricture recurrence, and with stent insertion, there is a risk of stent occlusion and migration. The endoscopic technique for BBSs is continuously advancing and we have previously proposed an endoscopic classification to assist with treatment therapies dependent on the location and etiology of biliary stricture [4].…”

Treatment of Long-Limb Biliary-Enteric Anastomotic Strictures: ERCP, PTBD, or EUS?

“…Benign biliary strictures following bile duct injury or liver transplantation are often refractory to non-surgical treatments such as endoscopic retrograde cholangiopancreatography (ERCP) or percutaneous transhepatic biliary drainage (PTBD) [1]. Endoscopic stricture dilation with or without stent placement is now the standard of care due to its lesser invasiveness [2]. Since in cases with a long-limb Roux-en-Y reconstruction, access to the biliary-enteric anastomosis is technically difficult or even impossible with conventional endoscopes, PTBD has assumed importance in this setting.…”