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Management of Biliary Strictures and Bile Duct Injury

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ERCP and EUS

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Abstract

Endoscopic treatment of benign and malignant biliary strictures and injuries consists of biliary stent placement. The choice of stent is strictly related to the type of stricture (benign, malignant, or iatrogenic), the resectable nature of the stricture and surrounding area, and the need for other therapies including chemotherapy, radiotherapy, and photodynamic therapy in palliative biliary drainage. Endoscopic management of postoperative biliary strictures is considered first-line therapy for the majority of patients. The approach to malignant biliary strictures should be multidisciplinary in order to provide the best treatment for the individual patient.

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Conflict of Interest

The authors declare no conflict of interest

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Authors and Affiliations

  1. Digestive Endoscopy Unit, Policlinico Universitario Agostino Gemelli, Largo Gemelli 8, Rome, 00168, Italy

    Prof. Guido Costamagna MD, PhD, Pietro Familiari MD, PhD & Andrea Tringali MD, PhD

  2. Digestive Endoscopy Unit, Catholic University of Rome, Gemelli Hospital, Largo A. Gemelli 8, Rome, 00168, Italy

    Ivo Boškoski MD, PhD

Authors
  1. Prof. Guido Costamagna MD, PhD
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  2. Ivo Boškoski MD, PhD
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  3. Pietro Familiari MD, PhD
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  4. Andrea Tringali MD, PhD
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Corresponding author

Correspondence to Ivo Boškoski MD, PhD .

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Editors and Affiliations

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

    Linda S. Lee

Video Caption

Video Caption

Video 8.1 Multiple plastic stents of benign biliary strictures

Benign Biliary Strictures After Laparoscopic Cholecystectomy

  • Benign biliary strictures after laparoscopic cholecystectomy can be successfully treated by endoscopy.

  • In this case a surgical clip was placed across the common bile duct.

  • A 0.018” guidewire was successfully advanced through the clip, and a dilator was passed as a wedge to open the clip. An 11.5 Fr stent was then placed to drain the bile ducts and dilate the stricture.

  • Three months later after stent removal, the biliary stricture was not completely dilated, and two 11.5 Fr stents were placed.

  • Three months later after the stents were removed, cholangiography showed satisfactory dilation of the stricture.

Benign Biliary Stricture After Surgery for Bile Duct Injury

  • In this patient a T tube was placed to repair a section of the common bile duct during laparoscopic cholecystectomy.

  • Due to the presence of a stricture two stents were placed after removal of the T tube.

  • Three months later the stents were removed and due to a persistent tight stricture, 3 large bore prostheses were placed.

  • Three months later the stricture was completely resolved.

Complex Benign Biliary Strictures

  • Complex strictures involving the hepatic confluence can also be treated endoscopically.

  • In this case, the tight stricture was dilated with a 4 mm balloon, and the number of the stents inserted was increased every 3 months up to three 11.5 Fr prostheses, resulting in resolution of the stricture after removal as seen during occlusion cholangiography.

Simultaneous Benign Biliary Stricture and Leak

  • A leak from the common bile duct and bile duct stricture are present in the same case.

  • After gently dilation of the stricture with a bougie dilator, one stent was placed mainly to treat the leak.

  • Aggressive stricture dilation was attempted 3 months later by balloon dilation and insertion of two stents.

  • Three months later 4 stents were placed, leading to resolution of the stricture after stent removal.

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Costamagna, G., Boškoski, I., Familiari, P., Tringali, A. (2015). Management of Biliary Strictures and Bile Duct Injury. In: Lee, L. (eds) ERCP and EUS. Springer, New York, NY. https://doi.org/10.1007/978-1-4939-2320-5_8

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