Endoscopic Management of Benign Biliary Strictures

Abstract

Benign biliary stricture result from different group of diseases with variable natural history. Table 1 lists the common causes of benign biliary stricture. Post-operative and inflammatory stricture are the most common. Endoscopic retrograde cholangiopancreatography (ERCP) has become a golden standard for treating benign biliary strictures. ERCP for the treatment of BBS is preferred over surgery and the percutaneous approach due to its low invasiveness, because it is safer and repeatable. Percutaneous approach can be useful in case of failure of ERCP for “rendezvous” techniques, in patients with surgically modified anatomy and non-accessible papilla. Multistenting procedure has been proven efficacy and safe treatment for benign biliary strictures. Despite significant advances in endoscopic techniques, differentiating malignant from benign strictures can still be challenging and chronic pancreatitis as well as non-anastomotic stricture post liver transplantation as cause of benign biliary strictures remain resistant to endoscopic treatments. The short term outcome following endoscopic treatment of benign biliary stricture is excellent but long-term outcome is poor mainly for high rate of recurrence. The use of covered metallic stents for the treatment of benign biliary strictures is still under investigation, clinical trials are underway to establish the best approach to the treatment of the benign biliary stricture. This article focuses on the endoscopic management of benign biliary strictures and elaborates on optimal treatments strategies for the more common causes.