Strategy for etiological diagnosis and treatment choice of benign biliary stricture
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The First Department of General Surgery, Southern Central Hospital of Yunnan Province/the First People's Hospital of Honghe State, Gejiu, Yunnan 661000, China

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R657.4

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    Abstract:

    Benign biliary stricture (BBS) is one of the main complications of hepatopancreatobiliary diseases and surgical procedures. The use of appropriate diagnostic methods and strategies to identify the cause of biliary stricture, can not only avoid the missed diagnosis of malignant biliary stricture with benign manifestations, but also avoid unnecessary surgical exploration in benign diseases, and has become a key element in the diagnosis and treatment of biliary stricture. Among numerous treatment methods for different causes, how to select and make a reasonable treatment strategy is also a problem faced by hepatopancreatobiliary surgeons. The etiological causes of BBS mainly include iatrogenic, infectious, inflammatory, obstructive, ischemic and autoimmune factors. In terms of diagnosis, CT, MRI and other imaging examinations are the first choice for finding biliary stricture and preliminarily determining the benign or malignant nature of the lesion. The etiological diagnosis of BBS can be made by combining the history, clinical manifestations and laboratory findings with the comprehensive evaluation of the collaborative multidisciplinary team including hepatobiliary surgeons, radiologists and pathologists. In terms of treatment, endoscopic retrograde cholangiopancreatography (ERCP) is still the first-line treatment for BBS; in the cases with anatomical changes or various reasons that cause the failure of endoscope to enter the biliary tract through the duodenal papilla, percutaneous transhepatic biliary drainage (PTBD) can be used for solution; for refractory BBS, surgery is considered as the final option; emerging techniques such as magnetic compression anastomosis, intraductal radiofrequency ablation and biodegradable stents have promising application prospects, but more research data are needed to evaluate the efficacy and safety.

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WU Lili, YUE Jinquan, LIU Zhiheng, AI Runyao, PENG Chengjiang, ZHONG Xingwei. Strategy for etiological diagnosis and treatment choice of benign biliary stricture[J]. Chin J Gen Surg,2023,32(2):296-308.
DOI:10.7659/j. issn.1005-6947.2023.02.016

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History
  • Received:August 26,2022
  • Revised:February 02,2023
  • Adopted:
  • Online: March 02,2023
  • Published: