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Diagnosing Biliary Strictures and Indeterminate Biliary Strictures

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ERCP and EUS

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Abstract

Biliary strictures can be benign or malignant. Accurate diagnosis is essential for treatment planning and the correct choice of therapy such as surgical resection or endoscopic stenting. Classification of biliary strictures as benign or malignant often involves a step-wise investigation that starts with patient history, laboratory tests and non-invasive cross-sectional imaging followed by invasive tests such as endoscopic retrograde cholangiopancreatography (ERCP) with or without cholangioscopy, and endoscopic ultrasound (EUS) with or without fine needle aspiration (FNA).

Often the nature of a stricture becomes clear after a limited initial investigation. However, in a subset of patients with the so-called “indeterminate biliary strictures” differentiation of malignant from benign ductal lesions may become a significant challenge. Although there is no consensus definition for “indeterminate strictures”, the term usually refers to biliary strictures where initial investigation including cross-sectional imaging such as computed tomography (CT) or magnetic resonance imaging of the abdomen and pathology has been unrevealing.

This chapter starts with an illustrative case followed by a review of various diagnostic modalities that may help in distinguishing malignant from benign strictures with emphasis on the role of ERCP.

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Authors and Affiliations

  1. Center for Endoscopy and Pancreatobiliary Disorders, Department of Gastroenterology and Hepatology/A31, Digestive Disease Institute, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH 44195, USA

    Mansour A. Parsi MD, MPH

  2. Digestive Disease Institute, Department of Gastroenterology and Hepatology, Cleveland, USA

    John J. Vargo MD, MPH

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  1. Mansour A. Parsi MD, MPH
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Correspondence to Mansour A. Parsi MD, MPH .

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  1. Gastroenterology, Hepatology, and Endoscopy, Brigham and Women’s Hospital, Boston, Massachusetts, USA

    Linda S. Lee

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Video 7.1 Cholangioscopy demonstrating biliary stricture with neovascularization around the distal end of the stricture

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Parsi, M., Vargo, J. (2015). Diagnosing Biliary Strictures and Indeterminate Biliary Strictures. In: Lee, L. (eds) ERCP and EUS. Springer, New York, NY. https://doi.org/10.1007/978-1-4939-2320-5_7

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