Endoscopic management of benign biliary strictures

Area of Science:

• Gastroenterology and Hepatology
• Interventional Endoscopy
• Biliary Tract Diseases

Background:

• Benign biliary strictures (BBSs) are common after procedures like cholecystectomy and liver transplantation.
• Accurate diagnosis of indeterminate strictures is crucial and relies on patient history and advanced tools.
• Previous surgical history significantly impacts BBS diagnosis and management strategies.

Purpose of the Study:

• To review current diagnostic and therapeutic approaches for benign biliary strictures.
• To evaluate the efficacy and potential of novel endoscopic therapies, including FCSEMSs.
• To compare the outcomes of plastic stenting versus FCSEMSs in BBS management.

Main Methods:

• Review of recent studies on BBS treatment modalities.
• Discussion of advanced diagnostic tools: specialized cytology, cholangioscopy, endoscopic ultrasound with fine needle aspiration (FNA), and intraductal ultrasound.
• Analysis of endoscopic retrograde cholangiopancreatography (ERCP) techniques, including guidewire traversal, balloon dilatation, and plastic stent placement.
• Evaluation of fully covered self-expanding metal stents (FCSEMSs) as an alternative therapy.

Main Results:

• Progressive plastic stenting requires multiple ERCPs but achieves 80% long-term dilation.
• FCSEMSs are a promising, less technically demanding option for non-hilar BBSs, potentially reducing ERCPs and costs.
• A single FCSEMS can achieve the dilation of three side-by-side plastic stents.

Conclusions:

• Advanced diagnostic techniques improve the characterization of indeterminate biliary strictures.
• While plastic stenting is effective, it is technically demanding and requires frequent exchanges.
• FCSEMSs represent a significant advancement in managing non-hilar BBSs, offering a potentially more efficient and cost-effective treatment option.