Biliary Tract: Bile Duct Stricture

Bile Duct Stricture

Definition

  • Stricture Within the Biliary System

Causes

  • Iatrogenic Ischemia After Laparoscopic Cholecystectomy (Most Common)
  • Chronic Infection (Pancreatitis)
  • Choledocholithiasis
  • Trauma
  • Cancer
  • Mirizzi Syndrome
  • Radiation
  • Primary Sclerosing Cholangitis
  • Portal Cholangiopathy

Presentation

  • Sx: Jaundice or Cholangitis
  • Eventually Develop Cirrhosis

Bismuth Classification (Same as Biliary Injury)

  • Type I: > 2 cm from Hepatic Duct Confluence
  • Type II: < 2 cm from Hepatic Duct Confluence
  • Type III: At Confluence but Patent
  • Type IV: At Confluence but Not Patent
  • Type V: Involve Aberrant Right Hepatic Duct

Diagnosis

  • Dx: MRCP

Treatment

  • Primary Tx: ERCP & Stent
    • If Anatomy Inaccessible (Hepaticojejunostomy, etc.): Percutaneous Transhepatic Cholangiography & Dilation
  • If Fails: Surgery (Choledochojejunostomy or Hepaticojejunostomy)

2 cm Bile Duct Stricture on ERCP 1

References

  1. Kakodkar S, Omar H, Cabrera J, Chi K. Eosinophilic Pancreatitis Diagnosed With Endoscopic Ultrasound. ACG Case Rep J. 2015 Jul 9;2(4):239-41. (License: CC BY-NC-ND-4.0)