Surgical approaches to strictures in primary sclerosing cholangitis

Primary sclerosing cholangitis (PSC) is an idiopathic inflammatory disease resulting in multifocal intra- and extrahepatic biliary strictures. Dominant strictures occur commonly in PSC and may contribute to the progressive hepatic fibrosis in this disease. Extrahepatic bile duct resection should be considered for selected noncirrhotic patients with symptomatic biliary obstruction and dominant strictures, particularly in those who fail in endoscopic therapy. In addition, patients with dominant strictures and equivocal results on cancer screening tests should be managed with resection rather than prolonged efforts at cancer diagnosis.