STRATEGY FOR CLINICAL MANAGEMENT OF BENIGN BILIARY STRICTURES

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Abstract

ABSTRACT

Benign biliary strictures (BBS) can present serious challenges in clinical management. We present a strategy for selecting therapeutic approaches to BBS based on our institute experience. Stricture etiology is important for developing a treatment plan, as it often determines the anatomical sites and structure of the stricture. If the initial passage of a guidewire through the stricture fails, surgical correction becomes the only option. Otherwise, non-surgical endoscopic procedures such as percutaneous transhepatic or transpapillary balloon dilation with or without stent insertion provides a good outcome in most cases. However, patients with BBS of Bismuth type III/IV or those due to pancreatitis tend to present more difficulty for successful treatment by endoscopic procedures. The placement of double stents across the stricture may be beneficial to maintain greater diameter after dilation. In addition, endoscopic sphincterotomy required for stent emplacement could increase the chance of reflux cholangitis, especially in patients with bile duct strictures.

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