CHU Estaing, Service de médecine digestive et hépatobiliaire, 1, place Lucie-Aubrac, 63003 Clermont-Ferrand, France
Institut Pascal, UMR 6602 UCA CNRS SIGMA, Thérapies guidées par l’image, TGI. 63100 Clermont-Ferrand, France
Making the proof of benign biliary duct stricture is a challenge. Its clinical show-up: Jaundice, angiocholitis or isolated elevation of liver enzymes are not informative about benign vs malignant nature of the stricture. If tomodensitometry and biliary duct MRI assess the general and regional expansion, endoscopic sampling remains essential. The first line endoscopic examination is endoscopic ultrasound (EUS) guided biopsy. The rate of undetermined biliary duct stricture remains high after EUS guided biopsy despite its combination to retrograde cholangiography. Nowadays this rate is lowered thanks to the high diagnostic accuracy of cholangioscopy and confocal endomicroscopy. The endoscopic treatment is a first alternative to surgery. Iterative procedures are required to calibrate properly benign biliary duct and therapeutic failure cannot be established before one year treatment. The cause of the stricture guides the technical choice: Dilation is restricted to primary cholangitis sclerosis. Metallic stents are suitable in case of biliary duct stricture associated to chronic pancreatitis. Plastic stenting remains useful to treat anastomotic strictures appearing after orthotopic liver transplantation.
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