Endoscopic therapy of benign biliary strictures

Area of Science:

• Gastroenterology and Hepatology
• Interventional Endoscopy

Background:

• Benign biliary strictures are increasingly managed with endoscopic techniques, shifting from traditional surgery.
• Confirmation of benign stricture nature is crucial for selecting appropriate therapy.
• Endoscopy is the first-line approach for post-liver transplant anastomotic strictures and Bismuth I/II post-operative strictures.

Discussion:

• Endoscopic therapy for chronic pancreatitis-related strictures is reserved for non-surgical candidates.
• The preferred endoscopic method involves aggressive dilation and multiple plastic stent placement.
• Uncovered self-expandable metal stents are not recommended due to poor long-term outcomes.

Key Insights:

• Endoscopy offers a minimally invasive alternative to surgery for benign biliary strictures.
• Plastic stents are favored over uncovered metal stents for long-term management.
• Specific stricture types, like those from chronic pancreatitis, present unique therapeutic challenges.

Outlook:

• Covered metal stents and bioabsorbable stents require further investigation for efficacy.
• Therapeutic endoscopy for biliary strictures remains an active area for research and innovation.
• Optimizing endoscopic techniques can improve patient outcomes and reduce invasiveness.