Benign biliary strictures related to chronic pancreatitis: balloons, stents, or surgery

Benign biliary strictures are seen in a subset of patients with chronic pancreatitis. Most patients are asymptomatic and require no intervention. In some patients, benign strictures can become symptomatic. In these patients, the aim of biliary drainage is to prevent long-term complications such as recurrent cholangitis and secondary biliary cirrhosis. The possibility of a malignant stricture should always be excluded. Successful endoscopic drainage of biliary obstruction has no influence on pain pattern in patients with chronic pancreatitis. At the first diagnosis of a symptomatic biliary stricture due to chronic pancreatitis, a polyethylene stent can be inserted endoscopically. If the stricture is still present despite stent exchange with serial insertion of multiple stents every 3 months for 1 year, surgery is indicated as definitive treatment. The role of self-expandable metal stents in the management of benign biliary strictures due to chronic pancreatitis is unclear, but they may be useful for nonoperative candidates and a select group of patients in whom surgery is planned. The aim of surgical therapy is to definitively treat the benign biliary stricture, especially in younger patients, who presumably have a longer lifespan.