Current treatment of benign biliary strictures

Area of Science:

• Gastroenterology and Hepatology
• Interventional Endoscopy

Background:

• Benign biliary strictures are common complications requiring effective treatment.
• Endoscopic therapy is a primary modality for managing various benign biliary strictures.

Approach:

• Endoscopic retrograde cholangiopancreatography (ERCP) with stent placement is the cornerstone of treatment.
• Multiple large-bore plastic stents are temporarily placed across the stricture.
• Surgical intervention is reserved for specific complex cases or non-compliant patients.

Key Points:

• Common indications include post-cholecystectomy, primary sclerosing cholangitis, post-transplant anastomotic strictures, and chronic pancreatitis.
• Endoscopy is safe, repeatable, and should be attempted even when surgery is an option.
• Uncovered self-expandable metal stents are contraindicated; covered stents may be used selectively.

Conclusions:

• Temporary stenting with multiple plastic stents is the recommended endoscopic approach.
• Endoscopic management offers a safe and effective alternative to surgery for many benign biliary strictures.