Semin intervent Radiol 2021; 38(03): 255-262
DOI: 10.1055/s-0041-1731086
Review Article

Biliary Strictures: Etiologies and Medical Management

Terrance Rodrigues
1   Division of Gastroenterology and Hepatology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
,
Justin R. Boike
1   Division of Gastroenterology and Hepatology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
› Author Affiliations

Abstract

Biliary strictures have several etiologies that can broadly be classified into benign and malignant causes. The clinical presentation is variable with strictures identified incidentally on imaging or during the evaluation of routine laboratory abnormalities. Symptoms and cholangitis lead to imaging that can diagnose biliary strictures. The diagnosis and medical management of biliary strictures will be discussed in this article.



Publication History

Article published online:
10 August 2021

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  • References

  • 1 Tummala P, Munigala S, Eloubeidi MA, Agarwal B. Patients with obstructive jaundice and biliary stricture  ± mass lesion on imaging: prevalence of malignancy and potential role of EUS-FNA. J Clin Gastroenterol 2013; 47 (06) 532-537
  • 2 Lokich JJ, Kane RA, Harrison DA, McDermott WV. Biliary tract obstruction secondary to cancer: management guidelines and selected literature review. J Clin Oncol 1987; 5 (06) 969-981
  • 3 Kruse EJ. Palliation in pancreatic cancer. Surg Clin North Am 2010; 90 (02) 355-364
  • 4 Porta M, Fabregat X, Malats N. et al. Exocrine pancreatic cancer: symptoms at presentation and their relation to tumour site and stage. Clin Transl Oncol 2005; 7 (05) 189-197
  • 5 Modolell I, Guarner L, Malagelada JR. Vagaries of clinical presentation of pancreatic and biliary tract cancer. Ann Oncol 1999; 10 (Suppl. 04) 82-84
  • 6 Vauthey JN, Blumgart LH. Recent advances in the management of cholangiocarcinomas. Semin Liver Dis 1994; 14 (02) 109-114
  • 7 Bergquist A, Ekbom A, Olsson R. et al. Hepatic and extrahepatic malignancies in primary sclerosing cholangitis. J Hepatol 2002; 36 (03) 321-327
  • 8 Boberg KM, Bergquist A, Mitchell S. et al. Cholangiocarcinoma in primary sclerosing cholangitis: risk factors and clinical presentation. Scand J Gastroenterol 2002; 37 (10) 1205-1211
  • 9 Viesca MFY, Arvanitakis M. Early diagnosis and management of malignant distal biliary obstruction: a review on current recommendations and guidelines. Clin Exp Gastroenterol 2019; 12: 415-432
  • 10 Boulay BR, Birg A. Malignant biliary obstruction: from palliation to treatment. World J Gastrointest Oncol 2016; 8 (06) 498-508
  • 11 Judah JR, Draganov PV. Endoscopic therapy of benign biliary strictures. World J Gastroenterol 2007; 13 (26) 3531-3539
  • 12 Kukar M, Wilkinson N. Surgical management of bile duct strictures. Indian J Surg 2015; 77 (02) 125-132
  • 13 Kim PTW, Marquez M, Jung J. et al. Long-term follow-up of biliary complications after adult right-lobe living donor liver transplantation. Clin Transplant 2015; 29 (05) 465-474
  • 14 Shanbhogue AKP, Tirumani SH, Prasad SR, Fasih N, McInnes M. Benign biliary strictures: a current comprehensive clinical and imaging review. AJR Am J Roentgenol 2011; 197 (02) W295-W306
  • 15 Clark RA, Gallant TE. Bile duct strictures associated with hepatic arterial infusion chemotherapy. Gastrointest Radiol 1987; 12 (02) 148-151
  • 16 Escorsell A, Parés A, Rodés J, Solís-Herruzo JA, Miras M, de la Morena E. Spanish Association for the Study of the Liver. Epidemiology of primary sclerosing cholangitis in Spain. J Hepatol 1994; 21 (05) 787-791
  • 17 Lee Y-M, Kaplan MM. Primary sclerosing cholangitis. N Engl J Med 1995; 332 (14) 924-933
  • 18 Rosen CB, Nagorney DM, Wiesner RH, Coffey Jr RJ, LaRusso NF. Cholangiocarcinoma complicating primary sclerosing cholangitis. Ann Surg 1991; 213 (01) 21-25
  • 19 Abdallah AA, Krige JEJ, Bornman PC. Biliary tract obstruction in chronic pancreatitis. HPB (Oxford) 2007; 9 (06) 421-428
  • 20 Aranha GV, Prinz RA, Freeark RJ, Greenlee HB. The spectrum of biliary tract obstruction from chronic pancreatitis. Arch Surg 1984; 119 (05) 595-600
  • 21 Wisløoff F, Jakobsen J, Osnes M. Stenosis of the common bile duct in chronic pancreatitis. Br J Surg 1982; 69 (01) 52-54
  • 22 Vitale GC, Reed Jr DN, Nguyen CT, Lawhon JC, Larson GM. Endoscopic treatment of distal bile duct stricture from chronic pancreatitis. Surg Endosc 2000; 14 (03) 227-231
  • 23 Naitoh I, Nakazawa T, Ohara H. et al. Clinical significance of extrapancreatic lesions in autoimmune pancreatitis. Pancreas 2010; 39 (01) e1-e5
  • 24 Kamisawa T, Takuma K, Egawa N, Tsuruta K, Sasaki T. Autoimmune pancreatitis and IgG4-related sclerosing disease. Nat Rev Gastroenterol Hepatol 2010; 7 (07) 401-409
  • 25 Nashed C, Sakpal SV, Shusharina V, Chamberlain RS. Eosinophilic cholangitis and cholangiopathy: a sheep in wolves clothing. HPB Surg 2010; 2010: 906496
  • 26 Alam I, Levenson SD, Ferrell LD, Bass NM. Diffuse intrahepatic biliary strictures in sarcoidosis resembling sclerosing cholangitis. Case report and review of the literature. Dig Dis Sci 1997; 42 (06) 1295-1301
  • 27 Vakil NB, Schwartz SM, Buggy BP. et al. Biliary cryptosporidiosis in HIV-infected people after the waterborne outbreak of cryptosporidiosis in Milwaukee. N Engl J Med 1996; 334 (01) 19-23
  • 28 Wilcox CM, Mönkemüller KE. Hepatobiliary diseases in patients with AIDS: focus on AIDS cholangiopathy and gallbladder disease. Dig Dis 1998; 16 (04) 205-213
  • 29 Naseer M, Dailey FE, Juboori AA, Samiullah S, Tahan V. Epidemiology, determinants, and management of AIDS cholangiopathy: a review. World J Gastroenterol 2018; 24 (07) 767-774
  • 30 Ducreux M, Buffet C, Lamy P. et al. Diagnosis and prognosis of AIDS-related cholangitis. AIDS 1995; 9 (08) 875-880
  • 31 Cello JP. Acquired immunodeficiency syndrome cholangiopathy: spectrum of disease. Am J Med 1989; 86 (05) 539-546
  • 32 Liberman E, Yen TS. Foamy macrophages in acquired immunodeficiency syndrome cholangiopathy with encephalitozoon intestinalis. Arch Pathol Lab Med 1997; 121 (09) 985-988
  • 33 Cosenza CA, Durazo F, Stain SC, Jabbour N, Selby RR. Current management of recurrent pyogenic cholangitis. Am Surg 1999; 65 (10) 939-943
  • 34 Lim JH. Radiologic findings of clonorchiasis. AJR Am J Roentgenol 1990; 155 (05) 1001-1008
  • 35 Park MS, Yu JS, Kim KW. et al. Recurrent pyogenic cholangitis: comparison between MR cholangiography and direct cholangiography. Radiology 2001; 220 (03) 677-682
  • 36 de Vries Y, von Meijenfeldt FA, Porte RJ. Post-transplant cholangiopathy: Classification, pathogenesis, and preventive strategies. Biochim Biophys Acta Mol Basis Dis 2018; 1864 (4, Pt B): 1507-1515
  • 37 Mourad MM, Algarni A, Liossis C, Bramhall SR. Aetiology and risk factors of ischaemic cholangiopathy after liver transplantation. World J Gastroenterol 2014; 20 (20) 6159-6169
  • 38 Skaro AI, Jay CL, Baker TB. et al. The impact of ischemic cholangiopathy in liver transplantation using donors after cardiac death: the untold story. Surgery 2009; 146 (04) 543-552 , discussion 552–553
  • 39 Kasper HU, Dries V, Drebber U, Stippel D, Reinhold K, Dienes HP. Florid ischemic cholangitis due to leucocytoclastic vasculitis. J Gastroenterol 2004; 39 (02) 188-191
  • 40 Saini S. Imaging of the hepatobiliary tract. N Engl J Med 1997; 336 (26) 1889-1894
  • 41 Hann LE, Greatrex KV, Bach AM, Fong Y, Blumgart LH. Cholangiocarcinoma at the hepatic hilus: sonographic findings. AJR Am J Roentgenol 1997; 168 (04) 985-989
  • 42 Condat B, Vilgrain V, Asselah T. et al. Portal cavernoma-associated cholangiopathy: a clinical and MR cholangiography coupled with MR portography imaging study. Hepatology 2003; 37 (06) 1302-1308
  • 43 Khuroo MS, Yattoo GN, Zargar SA. et al. Biliary abnormalities associated with extrahepatic portal venous obstruction. Hepatology 1993; 17 (05) 807-813
  • 44 Bowlus CL, Olson KA, Gershwin ME. Evaluation of indeterminate biliary strictures. Nat Rev Gastroenterol Hepatol 2016; 13 (01) 28-37
  • 45 Fevery J. Bilirubin in clinical practice: a review. Liver Int 2008; 28 (05) 592-605
  • 46 Kwo PY, Cohen SM, Lim JK. ACG clinical guideline: evaluation of abnormal liver chemistries. Am J Gastroenterol 2017; 112 (01) 18-35
  • 47 Hayat JO, Loew CJ, Asrress KN, McIntyre AS, Gorard DA. Contrasting liver function test patterns in obstructive jaundice due to biliary strictures [corrected] and stones. QJM 2005; 98 (01) 35-40
  • 48 Pleskow DK, Berger HJ, Gyves J, Allen E, McLean A, Podolsky DK. Evaluation of a serologic marker, CA19-9, in the diagnosis of pancreatic cancer. Ann Intern Med 1989; 110 (09) 704-709
  • 49 Ćwik G, Wallner G, Skoczylas T, Ciechański A, Zinkiewicz K. Cancer antigens 19-9 and 125 in the differential diagnosis of pancreatic mass lesions. Arch Surg 2006; 141 (10) 968-973 , discussion 974
  • 50 Paganuzzi M, Onetto M, Marroni P. et al. CA 19-9 and CA 50 in benign and malignant pancreatic and biliary diseases. Cancer 1988; 61 (10) 2100-2108
  • 51 Ballehaninna UK, Chamberlain RS. The clinical utility of serum CA 19-9 in the diagnosis, prognosis and management of pancreatic adenocarcinoma: an evidence based appraisal. J Gastrointest Oncol 2012; 3 (02) 105-119
  • 52 Koopmann J, Rosenzweig CNW, Zhang Z. et al. Serum markers in patients with resectable pancreatic adenocarcinoma: macrophage inhibitory cytokine 1 versus CA19-9. Clin Cancer Res 2006; 12 (02) 442-446
  • 53 Kaur S, Smith LM, Patel A. et al. A combination of MUC5AC and CA19-9 improves the diagnosis of pancreatic cancer: a multicenter study. Am J Gastroenterol 2017; 112 (01) 172-183
  • 54 Siqueira E, Schoen RE, Silverman W. et al. Detecting cholangiocarcinoma in patients with primary sclerosing cholangitis. Gastrointest Endosc 2002; 56 (01) 40-47
  • 55 Ramage JK, Donaghy A, Farrant JM, Iorns R, Williams R. Serum tumor markers for the diagnosis of cholangiocarcinoma in primary sclerosing cholangitis. Gastroenterology 1995; 108 (03) 865-869
  • 56 Marrero JA. Screening tests for hepatocellular carcinoma. Clin Liver Dis 2005; 9 (02) 235-251
  • 57 Liu B, Shi XH, Zhang FC, Zhang W, Gao LX. Antimitochondrial antibody-negative primary biliary cirrhosis: a subset of primary biliary cirrhosis. Liver Int 2008; 28 (02) 233-239
  • 58 Paumgartner G, Beuers U. Ursodeoxycholic acid in cholestatic liver disease: mechanisms of action and therapeutic use revisited. Hepatology 2002; 36 (03) 525-531
  • 59 Triantos CK, Koukias NM, Nikolopoulou VN, Burroughs AK. Meta-analysis: ursodeoxycholic acid for primary sclerosing cholangitis. Aliment Pharmacol Ther 2011; 34 (08) 901-910
  • 60 Wunsch E, Trottier J, Milkiewicz M. et al. Prospective evaluation of ursodeoxycholic acid withdrawal in patients with primary sclerosing cholangitis. Hepatology 2014; 60 (03) 931-940
  • 61 Tabibian JH, Lindor KD. Ursodeoxycholic acid in primary sclerosing cholangitis: if withdrawal is bad, then administration is good (right?). Hepatology 2014; 60 (03) 785-788
  • 62 Lindor KD, Kowdley KV, Luketic VAC. et al. High-dose ursodeoxycholic acid for the treatment of primary sclerosing cholangitis. Hepatology 2009; 50 (03) 808-814
  • 63 Chapman R, Fevery J, Kalloo A. et al; American Association for the Study of Liver Diseases. Diagnosis and management of primary sclerosing cholangitis. Hepatology 2010; 51 (02) 660-678
  • 64 Fickert P, Hirschfield GM, Denk G. et al; European PSC norUDCA Study Group. norUrsodeoxycholic acid improves cholestasis in primary sclerosing cholangitis. J Hepatol 2017; 67 (03) 549-558
  • 65 van Hoogstraten HJ, Vleggaar FP, Boland GJ. et al; Belgian-Dutch PSC Study Group. Budesonide or prednisone in combination with ursodeoxycholic acid in primary sclerosing cholangitis: a randomized double-blind pilot study. Am J Gastroenterol 2000; 95 (08) 2015-2022
  • 66 Knox TA, Kaplan MM. A double-blind controlled trial of oral-pulse methotrexate therapy in the treatment of primary sclerosing cholangitis. Gastroenterology 1994; 106 (02) 494-499
  • 67 Van Thiel DH, Carroll P, Abu-Elmagd K. et al. Tacrolimus (FK 506), a treatment for primary sclerosing cholangitis: results of an open-label preliminary trial. Am J Gastroenterol 1995; 90 (03) 455-459
  • 68 Talwalkar JA, Gossard AA, Keach JC, Jorgensen RA, Petz JL, Lindor RNKD. Tacrolimus for the treatment of primary sclerosing cholangitis. Liver Int 2007; 27 (04) 451-453
  • 69 Tabibian JH, Weeding E, Jorgensen RA. et al. Randomised clinical trial: vancomycin or metronidazole in patients with primary sclerosing cholangitis - a pilot study. Aliment Pharmacol Ther 2013; 37 (06) 604-612
  • 70 Färkkilä M, Karvonen AL, Nurmi H. et al. Metronidazole and ursodeoxycholic acid for primary sclerosing cholangitis: a randomized placebo-controlled trial. Hepatology 2004; 40 (06) 1379-1386
  • 71 Lee HW, Suh KS, Shin WY. et al. Classification and prognosis of intrahepatic biliary stricture after liver transplantation. Liver Transpl 2007; 13 (12) 1736-1742
  • 72 Ghazale A, Chari ST, Zhang L. et al. Immunoglobulin G4-associated cholangitis: clinical profile and response to therapy. Gastroenterology 2008; 134 (03) 706-715
  • 73 Tanaka A, Tazuma S, Okazaki K. et al. Clinical features, response to treatment, and outcomes of IgG4-related sclerosing cholangitis. Clin Gastroenterol Hepatol 2017; 15 (06) 920-926.e3
  • 74 Ebbo M, Grados A, Samson M. et al. Long-term efficacy and safety of rituximab in IgG4-related disease: data from a French nationwide study of thirty-three patients. PLoS One 2017; 12 (09) e0183844
  • 75 Carruthers MN, Topazian MD, Khosroshahi A. et al. Rituximab for IgG4-related disease: a prospective, open-label trial. Ann Rheum Dis 2015; 74 (06) 1171-1177
  • 76 Chen H, Siwo EA, Khu M, Tian Y. Current trends in the management of Mirizzi syndrome: a review of literature. Medicine (Baltimore) 2018; 97 (04) e9691
  • 77 Franceschet I, Zanetto A, Ferrarese A, Burra P, Senzolo M. Therapeutic approaches for portal biliopathy: a systematic review. World J Gastroenterol 2016; 22 (45) 9909-9920
  • 78 Abud A, Maddur H, Salem R. Management of symptomatic portal cavernoma cholangiopathy with transplenic portal vein recanalization and transjugular intrahepatic portosystemic shunt. Hepatology 2021; 73 (01) 456-459
  • 79 Kowdley KV. Ursodeoxycholic acid therapy in hepatobiliary disease. Am J Med 2000; 108 (06) 481-486
  • 80 Johnson GK, Geenen JE, Venu RP, Schmalz MJ, Hogan WJ. Treatment of non-extractable common bile duct stones with combination ursodeoxycholic acid plus endoprostheses. Gastrointest Endosc 1993; 39 (04) 528-531
  • 81 Pavlidis ET, Pavlidis TE. Pathophysiological consequences of obstructive jaundice and perioperative management. Hepatobiliary Pancreat Dis Int 2018; 17 (01) 17-21
  • 82 Negi SS, Sakhuja P, Malhotra V, Chaudhary A. Factors predicting advanced hepatic fibrosis in patients with postcholecystectomy bile duct strictures. Arch Surg 2004; 139 (03) 299-303
  • 83 Scobie BA, Summerskill WHJ. Hepatic cirrhosis secondary to obstruction of the biliary system. Am J Dig Dis 1965; 10 (02) 135-146