Clin Endosc.  2021 Nov;54(6):825-832. 10.5946/ce.2021.048.

Endoscopic Evaluation of Biliary Strictures: Current and Emerging Techniques

• Huynh R
• Owers C
• Pinto C
• Nguyen TM
• Kwok T

• KMID: 2522702
• DOI: http://doi.org/10.5946/ce.2021.048

Abstract

The diagnosis of biliary strictures in clinical practice can be challenging. Discriminating between benign and malignant biliary strictures is important to prevent the morbidity and mortality associated with incorrect diagnoses. Missing a malignant biliary stricture may delay surgery, resulting in poor prognostic outcomes. Conversely, it has been demonstrated that approximately 20% of patients who undergo surgery for suspected biliary malignancies have a benign etiology on histopathology. Traditional tissue sampling using endoscopic retrograde cholangiography does not always produce a definitive diagnosis, with a considerable proportion of cases remaining as indeterminate biliary strictures. Recent advances in endoscopic techniques have the potential to improve the diagnostic and prognostic accuracy of biliary strictures.

Keyword

Bile ducts; Biliary tract neoplasm; Cholestasis; Endoscopy; Pathologic constriction

Figure

• 

  Fig. 1. Endoscopic retrograde cholangiopancreatography image showing severe stenosis in the middle to distal third portion of the common bile duct with associated upstream dilatation.

• 

  Fig. 2. Hypoechoic mass as visualized using endoscopic ultrasound. (A) Pancreatic head. (B) Pancreatic tail.

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  Fig. 3. In confocal laser endomicroscopy, a low-power laser is directed onto a selected horizontal tissue plane and reflected to produce histological images. Out of focus reflected light are filtered out by the aperture, thus producing high-resolution images.

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