Common bile duct stricture as a late complication of upper abdominal radiotherapy

Cholangiocarcinoma following external beam radiotherapy: A report of two cases

“…Considering the reported occurrence of CCA and other hepatobiliary complications (21)(22)(23)(24)(25)(26)30,31), we hypothesize that chronic inflammatory reactions and resultant changes to the biliary epithelium following abdominal EBRT were fundamental to the development of CCA. However, it is unclear whether this represents a radiation-associated variant of the disease.…”

“…Radiation-induced liver disease is a known complication of EBRT (23), and there have also been reports of patients developing hepatocellular carcinoma (24) and benign biliary strictures (25,26) following EBRT.…”

Biliary Complications Associated with Selective Internal Radiation (SIR) Therapy for Unresectable Liver Malignancies

“…Experimental studies have shown that irradiation to bile ducts can lead to progressive obliterative arteritis of small vessels, with subsequent development of ductal fibrosis, biliary strictures, and biliary cirrhosis [11]. Several reports in the literature have described the development of symptomatic biliary strictures following external beam radiation therapy as primary or adjuvant treatment for various malignancies [12][13][14]. Patients usually present with obstructive jaundice with marked elevation of alkaline phosphatase level.…”

“…Patients usually present with obstructive jaundice with marked elevation of alkaline phosphatase level. The average radiation dose is 50 Gy, and the time elapsed between radiation treatment and symptoms ranges from 1 to 10 years [14]. The intolerance of normal liver parenchyma and bile ducts to irradiation has rendered external radiation therapy ineffective for treatment or palliation of hepatobiliary malignancies.…”

“…For strictures affecting only the extrahepatic biliary tree, resection of the stricture with either end-to-end biliary anastomosis or biliary-enteric anastomosis can achieve good long-term results [12][13][14]. In selected cases of radiation-induced common bile duct strictures, successful endoscopic treatments with self-expandable metallic stents with minimal morbidity and mortality have been reported [24].…”