Biliary stricture, particularly fibrotic stricture caused by laparoscopic cholecystectomy and liver transplantation, is one of the clinical challenges. Excessive deposition of extracellular matrix and epithelial-mesenchymal transition resulting from various causes (such as injury, ischemia, inflammation, and immune diseases) can lead to biliary fibrosis. This fibrosis subsequently causes biliary epithelial cell proliferation, thickening of the duct wall, and gradual fibrotic narrowing of the bile duct lumen. Biliary stricture leads to poor bile flow and stasis, which can result in conditions such as suppurative cholangitis, biliary sclerosis, and even liver failure, affecting patients' quality of life and overall survival rate. The TGF-β, Wnt, and Notch signaling pathways are important mechanisms leading to biliary fibrosis, with the Wnt/PCP signaling pathway of the non-canonical Wnt pathway playing a significant role in biliary epithelial cell proliferation and the fibrosis process. Fibroblast growth factors (FGF) can regulate the fibrosis process by promoting or inhibiting these signaling pathways, and different amounts of FGF have opposing effects on fibrosis; however, the specific mechanisms of their action are not well studied. Endoscopic retrograde cholangiopancreatography and percutaneous transhepatic cholangiography with stent placement are the first-line treatments for biliary stricture. Surgical treatment is reserved for patients with refractory biliary strictures or those where endoscopic stent placement is limited. Other treatment options include magnetic compression anastomosis, intraductal radiofrequency ablation, and photodynamic therapy. Tissue-engineered stents based on 3D printing, which have a biomimetic structure and good mechanical properties, show promise in partially restoring or replacing damaged tissue, enabling the regeneration and repair of the bile ducts, and thus have significant potential for clinical application. Additionally, bile duct organoids offer new avenues for biliary fibrosis repair in disease modeling, drug screening, and mechanism studies. However, these studies are still experimental despite the promising therapeutic outcomes of "artificial bile ducts" made from different active materials in animal models. Moreover, the impact of synthetic materials and bioactive factor-coated stents on the molecular mechanisms of biliary fibrosis has not been fully explored. This review focuses on the potential mechanisms of fibrotic biliary stricture and its treatment options to provide insights for clinical research and treatment of biliary stricture.