Endoscopic Diagnosis and Treatment of Benign Biliary Strictures

Cho, Young Deok

Abstract

Benign biliary strictures constitute about 25% of all biliary strictures. Benign biliary strictures are a heterogenous group of lesions with variousvariable pathogenesis. The majority of benign biliary strictures occur as a result of bile duct injury during surgery or as a consequence of bile duct repair after accidental injury, performing , choledochotomy, or performing duct-to-duct anastomosis after liver transplantation. However, bile duct strictures are also typical of other diseases, such as chronic pancreatitis, primary sclerosing cholangitis, and other uncommon cholangiopathies. The aim of treatment is to relieve the symptoms of biliary obstruction or cholangitis, and to prevent of secondary biliary cirrhosis. The Management of benign biliary stricture remains a challenge for both the surgeons and the therapeutic endoscopists. Surgery is, though traditionally considered as the mainstay of treatment, but this is associated with significant morbidity and variousvariable long-term outcomes. Endoscopic management, i.e., stricture dilatation and stent placement, is more appealing because it is less invasive, better tolerated, and it may be safer than operative management in selected patients. Recently, benign biliary strictures are now being increasing treated with endoscopic techniques. The Outcome of endoscopic management depends on both the etiology and location of the stricture. The benign nature of the stricture should be first confirmed in order to ensure appropriate therapy. The Current data suggest that the long-term results with using multiple plastic stent are superior to those with using a single plastic stent. Removable covered metal stents are also a good alternative. The role of bio-absorbable self-expanding stents for treating benign biliay strictures needs to be evaluated further.