Management of bile duct strictures. An evolving strategy

Area of Science:

• Gastroenterology
• Interventional Radiology
• Biliary Surgery

Background:

• Benign biliary strictures pose management challenges.
• Surgical reconstruction has historically been the primary treatment.
• Evaluating minimally invasive techniques is crucial for patient outcomes.

Purpose of the Study:

• To assess the role of interventional radiologic and endoscopic techniques in managing benign bile duct strictures.
• To compare outcomes between early and later treatment eras.
• To identify the efficacy of percutaneous transhepatic biliary dilatation for different stricture types.

Main Methods:

• Retrospective analysis of 194 patients with benign bile duct strictures treated between 1955 and 1990.
• Patients divided into two groups based on treatment era: 1955–1979 (n=138) and 1980–1989 (n=56).
• Minimum follow-up of 24 months, with over 3 years for 92% of patients.

Main Results:

• Recurrent stricture rates were similar between groups (21% vs. 23%).
• Reoperation rates significantly decreased in the later group (6% vs. 21%, P < .02).
• Percutaneous transhepatic biliary dilatation showed high success for anastomotic strictures (93%) but limited success for primary strictures (50%).

Conclusions:

• Surgical reconstruction remains the gold standard for primary bile duct strictures.
• Percutaneous transhepatic biliary dilatation offers a valuable option for anastomotic strictures.
• Minimally invasive approaches are evolving for benign biliary stricture management.