Current endoscopic approaches to biliary strictures

Abstract

Purpose of reviewTo summarize the current status and future perspectives of the endoscopic management of biliary strictures.Recent findingsIn addition to conventional diagnostic modalities, such as cross-sectional imaging and endoscopic ultrasonography (EUS), per-oral cholangioscopy is helpful for indeterminate biliary strictures. It allows direct visualization of the biliary tract and targeted biopsy. For distal malignant biliary obstruction (MBO), a self-expandable metal stent (SEMS) via endoscopic retrograde cholangiopancreatography (ERCP) is a standard of care. EUS-guided biliary drainage (EUS-BD) is an emerging alternative to percutaneous transhepatic biliary drainage in cases with failed ERCP. EUS-BD is also an effective salvage option for perihilar MBO, which can not be managed via ERCP or percutaneous transhepatic biliary drainage. Preoperative drainage is necessary for most jaundiced patients as neoadjuvant chemotherapy is widely administered for resectable and borderline resectable pancreatic cancer, and a SEMS is preferred in this setting, too. For benign biliary strictures, a covered SEMS can improve stricture resolution and reduce the number of endoscopic sessions as compared to plastic stents.SummaryERCP and EUS play a central role in the diagnosis and drainage for both malignant and benign biliary strictures.

Management of post-liver transplantation biliary stricture inaccessible by endoscopic retrograde cholangiopancreatography: A case report

“…The cause of BBS varies in patients, from post-LT biliary stricture to chronic inflammation[ 1 ]. Despite these various causes, a removable FC-SEMS is the preferred treatment for providing stricture resolution with sustained patency and reducing the number of endoscopic sessions[ 1 ].…”

“…The cause of BBS varies in patients, from post-LT biliary stricture to chronic inflammation[ 1 ]. Despite these various causes, a removable FC-SEMS is the preferred treatment for providing stricture resolution with sustained patency and reducing the number of endoscopic sessions[ 1 ]. In the present case, where a stricture was inaccessible by ERCP, either multiple plastic stents or an FC-SEMS would be considered to prolong patency.…”

“…Endoscopic retrograde cholangiopancreatography (ERCP) has become the standard treatment for benign biliary strictures (BBSs) associated with liver transplantation (LT) owing to the safety and efficacy of the technique[ 1 , 2 ]. However, a percutaneous transhepatic cholangioscopy (PTCS)-guided approach is sometimes required, particularly when ERCP is not feasible.…”

Principles of Palliative and Supportive Care in Pancreatic Cancer: A Review

“…Previously, in the event of failure to ensure drainage of the bile ducts, it was necessary to use PTBC or proceed to surgery. Today, the benefits of EURCP can be exploited with success [14]. One possibility is the detection of dilated bile ducts via EUS and their puncture in a suitable place.…”

Efficacy of a Novel Tapered Contrast Catheter for Endoscopic Ultrasound-Guided Hepaticogastrostomy: A Multicenter Study

“…Percutaneous transhepatic biliary drainage (PTBD) has previously been performed as an alternative to ERCP; however, it has a high rate of adverse events (AEs) [ 3 ]. Recently, Endoscopic ultrasound-guided biliary drainage (EUS-BD) has been widely performed instead of PTBD, and the efficacy of endoscopic ultrasound-guided hepaticogastrostomy (EUS-HGS) has been described in previous reports [ 4 , 5 , 6 ]. Although a high success rate of EUS-HGS has been reported [ 7 ], comprehensive identification and analysis of risk factors for AEs remain an area of ongoing research.…”