Pdf development of a swine benign biliary stricture. The longterm out endoscopic stenting is an authoritative alternative tool come of hepaticojejunostomy in the treatment of benign bile duct strictures. This volume covers the pathophysiology, epidemiology, presentation, diagnosis, medical and surgical management of benign biliary stenosis. Stricture dilation the dilation of benign bile duct strictures by either balloon or. When adequate biliary drainage was achieved, metal stents were removed. Laparoscopic hepaticojejunostomy for benign biliary. Benign biliary strictures are most commonly iatrogenic in nature and are a consequence of hepatobiliary surgery. This case report presents the use of the novel biliary bebs for postcholecystectomy perihilar benign biliary stricture. Abstract benign biliary strictures are common and occur either from hepato. Resolution of the benign biliary strictures was found in 28 of 36 patients 77. Inflammatory response follows the injury, resulting in collagen deposition, fibrosis, and focal narrowing, leading to stricture formation 3. Pdf management of benign biliary strictures biliary. Injury to the bile ducts is the inciting event in the development of benign bile duct strictures 3.
Pdf benign biliary strictures bbss may form from chronic inflammatory pancreaticobiliary pathologies, postoperative bileduct injury, or at. Migration may occur spontaneously and can be treated by delivering longer stents. Benign biliary strictures can be di cult to manage. Benign biliary strictures amenable to endoscopic dilation include those secondary to chronic pancreatitis, dominant strictures in sclerosing cholangitis, postoperative strictures, and strictures caused by stone disease. Strictures of the common bile duct may have a diverse origin 25, and the discrimination between benign and malignant stenoses in early stages has not been satisfactorily achieved yet 26. However, the optimal extraction time point remains unclear and stent migration has been a major concern. Pdf multidisciplinary approach to benign biliary strictures. A total of 868 patients with benign biliary strictures were included in this study. The surgical treatment of benign biliary strictures after hepaticojejunostomy is di. Longterm outcomes of a benign biliary stricture protocol. Postcholecystectomy bile duct stricture can develop even after several years of index surgery. Percutaneous management of benign and postoperative. Patients of 163 patients referred for treatment with diagnoses of benign strictures of the common bile duct between. This study conducted to establish a clinically relevant porcine bbs model by means of endobiliary radiofrequency ablation rfa.
The book is uniquely structured in a way that allows areas of controversy to be highlighted through the use of a two chapter format for each topic. Common hepatic or main bile duct stump 2 cm opening of the bile duct stump and sidetoside anastomosis with a jejunal loop type ii. Pathophysiologic features of bile duct strictures pathophysiologic mechanisms underlying the development of biliary strictures are different in benign and malignant conditions. Benign biliary strictures bbss may form from chronic inflammatory pancreaticobiliary pathologies, postoperative bileduct injury, or at biliary anastomoses following liver transplantation. Benign biliary strictures, fcsems, ercp, ptcd, chronic pancreatitis received. The major causes of benign biliary strictures were lithiasis 52. Keywords benign biliary benign strictures biliary biliary stents strictures endoscopic retrograde cholangiopancreatography introduction endoscopic therapy is considered the. Percutaneous treatment by balloon dilatation and long term externalinternal drainage is feasible in the majority of these patients. Current treatment of benign biliary strictures ncbi nih. Possibility of cholangiocarcinoma should always be kept in mind while dealing with patients presenting with delayed biliary stricture. Biliary strictures are usually seen in the advanced stages of chronic pancreatitis secondary to recurrent pancreaticobiliary inflammation resulting in fibrosis. Abstract benign biliary strictures are common and occur either from hepatobiliary surgery or from diseases including chronic pancreatitis and primary sclerosing cholangitis, among others.
The biliaryenteric anastomosis for benign biliary stricture is thus different from other biliaryenteric anastomosis as follows. Pathological effects of biliary obstruction biliary obstruction high local concentratio n of bile salts inflammatio n 6. Kaplanmeier analysis showed stricture patency probabilities of 84% at 1 year after treatment, 78% at 2 years, 74% at 5 years, and 67% at 10 years. Benign biliary strictures of the hepatic duct junction or bilioenteric anastomosis are di. Benign biliary stricture after yttrium90 radioembolization. The typical presentation is indolent and involves elevation of liver enzymes, constitutional symptoms, and obstructive jaundice with or without superimposed or recurrent cholangitis. The types of benign biliary strictures were i in 108 patients, ii in 144 patients, iii in 150 patients, iv in 156 patients, v in 66 patients, and vi in 244 patients. Treatment of postcholecystectomy biliary strictures with. A case series of 16 patients at a tertiary care centre in india manash ranjan sahoo 1, manwar sheikh ali 2, siddhant sarthak 2, jyotirmay nayak 3 1 department of surgery, aiims, bhubaneswar, odisha, india 2 department of general surgery, aiims, bhubaneswar, odisha, india 3 department of general surgery, scbmch, cuttack, odisha, india. When confronting a biliary stricture, both benign and malignant etiologies must be carefully considered as a variety of benign biliary strictures can masquerade as hilar cholangiocarcinoma cca. Cholangiocarcinoma and adenocarcinoma of the pancreas are the most common causes of malignant biliary obstruction. An additional interesting aspect is that a bebs can be placed stentinstent yshapedconfiguration, which may be useful for biliary drainage in complex benign or indeterminate biliary strictures.
Amongst them, benign biliary stricture is one such significant complication which is primarily managed by open surgery, but since advent of laparoscopy, there has been an increased interest in doing this repair laparoscopically. Endoscopic retrograde cholangiography erc was performed on 12 swine. Effective treatment of benign biliary strictures with a removable, fully covered, selfexpandable metal stent. Mainstays of noninvasive imaging for benign biliary strictures include ultrasound, contrastenhanced computed tomography and magnetic resonance imaging, magnetic resonance cholangiopancreatography, and computed tomography cholangiography. The objective of this study was to evaluate the efficacy and safety of this treatment modality using an fcsems with. Benign biliary strictures managed with the wallflex. Chronic pancreatitis results in obstruction of the intrapancreatic cbd and accounts for up to 10% of benign biliary strictures.
Benign biliary strictures bbss may form from chronic inflammatory pancreaticobiliary pathologies, postoperative bileduct injury, or at. Endoscopic management of benign biliary strictures after. Percutaneous treatment of benign biliary strictures is performed in almost all patients with strictures after hepaticojejunostomy with rouxeny reconstruction. Percutaneous management of benign and postoperative biliary. Benign biliary strictures may be dilated with hydrostatic balloons or graduated catheters passed over a guidewire. Benign biliary strictures represent a challenging problem to clinicians and patients. This is a retrospective study of 16 patients having obstructive jaundice due to benign biliary.
The process of operative management can be divided into following steps. Esophageal dilation, or stretching, is the preferred option in most cases. Interventional radiologists are often consulted to help identify and treat biliary strictures that can result from a variety of benign etiologies. Cause, classification, and clinical manifestations biliary stricture can be seen with a wide array of nonneoplastic causes. Eosinophilic cholangitisa challenging diagnosis of benign. Benign conditions include primary sclerosing cholangitis, chronic pancreatitis, choledocolithiasis, bile duct injury and infections, among others. Apr 01, 2016 benign biliary strictures bbss are often the consequence of iatrogenic injury during laparoscopic cholecystectomy or may arise after liver transplantation or a hepatic resection with ducttoduct biliary anastomosis. Effective treatment of benign biliary strictures with a. Apr 19, 2020 treatment for benign esophageal stricture varies depending on the severity and underlying cause. The large animal model with benign biliary stricture bbs is essential to undergo experiment on developing new devices and endoscopic treatment. Until a few years ago, surgery was the only available treatment for biliary strictures. Treatment aims to relieve symptoms of biliary obstruction, maintain longterm drainage, and preserve liver function. In western countries, iatrogenic stricture is the most common benign biliary stricture and accounts for up to 80% of all benign strictures 1, 2. Type i strictures are located more than 2 cm distal to confluence of left and right hepatic ducts, whereas.
Tocchi a, costa g, lepre ll, liotta g, mazzoni g, sita a. Original article surgical management of benign biliary. Benign biliary strictures managed with the wallflex biliary. Laparoscopic hepaticojejunostomy for benign biliary stricture. Abbreviations abs anastomotic biliary stricture asa american society of anesthesiologists bbs benign biliary stricture cbd common bile duct ci confidence interval crp creactive protein ddlt deceased donor liver transplantation ebs endoscopic biliary. The majority of benign strictures are iatrogenic, mainly because of bile duct. Pdf management of benign biliary strictures biliary enteric. Surgery is a valid option in cases of complete transection or ligation of the common bile duct, in selected patients with benign strictures related to. However, hilar biliary stricture where operative management is necessary 3. Role of fully covered selfexpandable metal stent for.
The treatment of many such strictures is endoscopic with evolving new approaches especially with fully. Pdf development of a swine benign biliary stricture model. In western countries, iatrogenic stricture is the most common benign biliary stricture and accounts for up to 80% of all benign strictures 1. Twenty of these patients were treated with endoscopic stenting and 22 with surgery. Important features of our series are 1 the long patient followup. Benign distal cbd strictures are seen in up to 346% of patients with chronic pancreatitis, a substantial proportion of whom may remain asymptomatic, and are incidentally diagnosed at ercp or mrcp. Postcholecystectomy partial biliary stricture leading to. Pdf current treatment of benign biliary strictures researchgate. Iatrogenic causes, such as cholecystectomy and orthotopic liver transplantation, are the most common causes of bbs. Use of a structured protocol for the percutaneous treatment of benign biliary strictures yields durable longterm results, suggesting that percutaneous treatment is an effective therapy. Longterm outcomes of a benign biliary stricture protocol jvir. Percutaneous management of benign biliary strictures. Biliary stricture, also known as bile duct stricture, occurs when the bile duct gets smaller or narrower.
Clinically, benign biliary stricture can pres ent with. Bilateral balloon expandable biodegradable stent ystent. Effective treatment of benign biliary authors 2016. Biliary strictures can be broadly classified as benign or malignant. The management landscape is constantly evolving, with the. Benign biliary strictures bbss have various origins, each with a different natural history and each demonstrating a different response to treatment. Magnetic compression anastomosis for treatment of benign. Biliary strictures can be broadly classified as benign or malignant biliary strictures mbss. Bile is a substance that helps in digestion of fatty food and excreting getting rid of harmful substances. Dec 01, 2020 benign biliary stricture was defined as newly detected biliary ductal dilatation of segmental or lobar biliary ducts. From 2010 to 2011, wallflex biliary rx fully covered metal stents were placed in 36 patients with benign biliary strictures in our hospital. Percutaneous transhepatic balloon dilatation of benign. Asiapacific consensus guidelines for endoscopic management of.
Differentiating benign and malignant biliary strictures is a challenging and important clinical scenario. Presentation after more than 5 years may occur in 30% of. Oct 17, 2018 however, endoscopic management of nonanastomotic biliary strictures is much more complex and challenging as compared with anastomotic biliary strictures. By and large, strictures of the bile duct in patients with obstructive jaundice should be considered malignant unless a benign etiology is ascertained.
This case report highlights the occurrence of such a stricture 11 years after. Untreated biliary strictures can lead to complications, such as chronic cholestasis, jaundice, recurrent sepsis, and secondary biliary cirrhosis, which can have severe rami. We performed a large prospective multinational study to study the ability to remove these stents after extended indwell and the frequency and durability of stricture resolution. For benign strictures, newer approaches, such as largebore catheterization, cuttingballoon dilation, and placement of retrievable covered stents. The role of ercp in benign diseases of the biliary tract. Oct 23, 2018 biliary strictures can be broadly classified as benign or malignant biliary strictures mbss.
Therefore, patients could undergo a major surgery despite. Surgery is a valid option in cases of complete transection or ligation of the common bile duct, in selected patients with benign strictures related to chronic. Treatment aims to relieve symptoms of biliary obstruction. Endoscopic management of a benign biliary stricture.
Common hepatic duct stump 2 cm opening of the stump extending to the left duct. Patients of 163 patients referred for treatment with diagnoses of benign strictures of the common bile duct between january 1, 1975, and july 1, 1998, we studied 42 patients with postcholecystectomy stricture and a followup longer than 60 months. Approach to management of indeterminate biliary stricture. If tumors invaded the biliary duct or the main portal vein when biliary duct dilatation was detected, it was considered malignant biliary obstruction. In a nonrandomized study at centers in 11 countries, 187 patients with benign biliary strictures received fcsems. Jul 01, 2012 the incidence rate of major bile duct injury is 0. The bile duct is the tube that takes bile from the liver to the small bowel. Benign biliary stricture is an infrequent condition and the majority occur following cholecystectomy. Endoscopic therapy is considered the first line in managing benign biliary strictures bbs 1, 2.
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