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cbd stricture medical

Cbd stricture medical

Approximately 70–80% of patients respond to medical therapy and do not need urgent intervention. Patients not having a response to empiric antibiotic therapy within 24 h or those with hypotension requiring vasopressors, disseminated intravascular coagulation, or multiorgan system failure should be considered for immediate biliary decompression, which can be performed surgically, percutaneously, or endoscopically. Endoscopic or percutaneous decompression is often associated with lower morbidity and should be considered first.

This condition and hepatolithiasis are prevalent in Southeast Asia. It is characterized by recurrent attacks of suppurative cholangitis with strictures and dilatation of bile ducts and numerous pigment stones in the intrahepatic and extrahepatic bile ducts. It is thought to be precipitated by an infestation of liver flukes and round worms.

Bismuth and Majno 12 proposed a classification for biliary stricture based on its location ( Fig. 1 ). This classification helps the surgeon to choose the most appropriate surgical approach because it defines the level in which healthy biliary mucosa is available for repair and anastomosis. Type I biliary strictures, which occur more than 2 cm from the hepatic confluence, are the easiest to repair with a success rate of up to 100%. 13

In postsurgery patients with an external biliary fistula or T tube, contrast medium can be injected into the biliary system through the tube or the fistula. This outlines the intrahepatic and extrahepatic bile ducts and delineates the site of stricture and the anatomy of the fistula. This study can precipitate cholangitis; therefore, patients should receive antibiotic prophylaxis.

Histologic findings

Benign strictures of the biliary tract are associated with a broad spectrum of signs and symptoms, ranging from subclinical disease with mild elevation of liver enzymes to complete obstruction with jaundice, pruritus and cholangitis, and ultimately biliary cirrhosis. 1

Hepatic artery infusion of 5-fluorodeoxyuridine (FdUrd, FUDR) or other chemotherapeutic drugs may cause bile duct strictures.

Patients with cholangitis whose conditions fail to improve with conservative treatment usually require urgent decompression of the obstructed biliary system. Treatment options for bile duct strictures include endoscopic or percutaneous balloon dilatation and insertion of an endoprosthesis or surgery.

Sphincter of Oddi dysfunction or papillary stenosis

A few cases of idiopathic benign bile duct strictures have been reported.

Decompression of the biliary system is usually performed endoscopically, with placement of a nasobiliary tube or one or two 10F–12F stents after sphincterotomy. Thereafter, elective replacement of the stents seems desirable to prevent cholangitis by stent occlusion because polyethylene stents generally clog in 3–4 months. Alternatives to ERCP are percutaneous transhepatic biliary drainage and surgical decompression. Sphincterotomy and endoscopic balloon dilatation alone is not a reliable method of treating benign strictures. Percutaneous treatment by balloon dilatation followed by short- to intermediate-term stent placement appears to provide a more durable result. 14 The role of metallic stents in this situation needs further evaluation. 15

Cbd stricture medical

However, the most common etiology for biliary strictures is malignancies.[13] Both pancreatic head cancer and cholangiocarcinoma are attributed to the majority of malignant biliary strictures. Others include periampullary cancer, gallbladder carcinoma, hepatocellular carcinoma, lymphoma, and metastasis to regional solid organs and lymph nodes.[6][14][6][15]

Last Update: June 5, 2021 .

Affiliations

StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-.

Authors

Globally, the incidence of biliary strictures is thought to be on the rise primarily because of the iatrogenic bile duct injuries resulting from the widespread practice of laparoscopic cholecystectomy. Multiple strategies like the critical view of safety have been suggested to minimize bile duct injuries and associated morbidity from bile leaks and strictures.[16] The estimated rate of biliary injuries is about 0.7% after laparoscopic cholecystectomy. Most of these injuries are minor injuries or bile leaks. Biliary strictures are rare in the pediatric age group.[17] There is no published difference in incidence or prevalence of biliary strictures in males as compared to females though some risk factors like alcoholic chronic pancreatitis are commoner in males.