Endoscopic therapy of benign biliary strictures

Benign biliary strictures result from many etiologies, including postoperative injuries, anastomotic strictures, and chronic pancreatitis. Therapy is generally required to relieve symptoms of cholestasis or cholangitis and prevent secondary cirrhosis. Surgery has been the traditional method for treatment of benign biliary strictures but is associated with significant morbidity and variable long-term outcomes. More research is needed to define the best methods and materials for various patient populations. Endoscopic management, including stricture dilation and stent placement, is more appealing because it is less invasive and better tolerated, but repeated treatments are required. Outcomes of endoscopic management depend on both the etiology and the location of the stricture. Accumulating data suggest that long-term success is substantially greater when multiple rather than single plastic stents are placed. Uncovered metallic stents are problematic and generally not recommended. Emerging alternatives to plastic stents include the placement of removable covered metallic stents.