Multidisciplinary Management of Benign Biliary Strictures

Abstract

Benign biliary strictures can occur as sequelae after inflammatory processes of the hepato-pancreato-biliary system; they can also occur as a major complication after liver and pancreas surgery. Such strictures are so strongly associated with outcomes after liver and pancreas surgery that they are now included as a required “core outcome” for reporting after a liver transplant. Options for the management of benign biliary strictures include endoscopic, percutaneous, and surgical techniques. Retrograde endoscopy or antegrade percutaneous interventions are first-line therapies, with surgical management reserved for recalcitrant cases. Overall, biliary strictures are best managed by multidisciplinary teams at tertiary-care centers to ensure that the most advanced and least invasive approaches are available. This article reviews all three techniques for the management of benign biliary strictures, with a focus on multidisciplinary approaches for complex stricture disease.

Keywords

biliary stricture - endoscopic stenting - endoscopic retrograde cholangiopancreatography - percutaneous transhepatic cholangiography

Publikationsverlauf

Eingereicht: 19. November 2024

Angenommen: 17. Dezember 2024

Artikel online veröffentlicht:
03. April 2025

• References

• 1 Nakai Y, Isayama H, Wang HP. et al. International consensus statements for endoscopic management of distal biliary stricture. J Gastroenterol Hepatol 2020; 35 (06) 967-979
• 2 Wehrle CJ, Stackhouse KA, Chang J. et al. Evaluating approaches to diagnosis and management of idiopathic acute pancreatitis. HPB (Oxford) 2023; 25 (10) 1187-1194
• 3 Assis DN, Bowlus CL. Recent advances in the management of primary sclerosing cholangitis. Clin Gastroenterol Hepatol 2023; 21 (08) 2065-2075
• 4 Boberg KM, Lind GE. Primary sclerosing cholangitis and malignancy. Best Pract Res Clin Gastroenterol 2011; 25 (06) 753-764
• 5 Buis CI, Verdonk RC, Van der Jagt EJ. et al. Nonanastomotic biliary strictures after liver transplantation, part 1: radiological features and risk factors for early vs. late presentation. Liver Transpl 2007; 13 (05) 708-718
• 6 Wehrle CJ, Woo K, Raj R. et al. Comparing outcomes of minimally invasive and open hepatectomy for primary liver malignancies in patients with low-MELD cirrhosis. J Gastrointest Surg 2023; 27 (11) 2424-2433
• 7 Wehrle CJ, Zhang M, Khalil M. et al. Impact of back-to-base normothermic machine perfusion on complications and costs: a multicenter, real-world risk-matched analysis. Ann Surg 2024; 280 (02) 300-310
• 8 Wehrle CJ, de Goeij FHC, Zhang M. et al. Core outcome sets and benchmarking complications: defining best practices for standardized outcome reporting in liver transplantation. Liver Transpl 2024;
• 9 Ashat M, Berei J, El-Abiad R, Khashab MA. Benign biliary strictures: a comprehensive review. Turk J Gastroenterol 2024; 35 (07) 513-522
• 10 David Y, Yang D, DiMaio C. Management of benign biliary strictures. In: Cameron JL, Cameron AM. eds. Current Surgical Therapy. 14th ed.. Elsevier; 2023
• 11 Visrodia KH, Tabibian JH, Baron TH. Endoscopic management of benign biliary strictures. World J Gastrointest Endosc 2015; 7 (11) 1003-1013
• 12 Kaffes AJ. Management of benign biliary strictures: current status and perspective. J Hepatobiliary Pancreat Sci 2015; 22 (09) 657-663
• 13 Mukund A, Rajesh S, Agrawal N, Arora A, Arora A. Percutaneous management of resistant biliary-enteric anastomotic strictures with the use of a combined cutting and conventional balloon cholangioplasty protocol: a single-center experience. J Vasc Interv Radiol 2015; 26 (04) 560-565
• 14 Kamal F, Ali Khan M, Lee-Smith W. et al. Metal versus plastic stents in the management of benign biliary strictures: systematic review and meta-analysis of randomized controlled trials. Eur J Gastroenterol Hepatol 2022; 34 (05) 478-487
• 15 Corvera CU, Wineski AD. Benign biliary strictures and biliary fistulae. In: Jarnagin WR. ed. Blumgart's Surgery of the Liver, Biliary Tract and Pancreas. 7th ed.. Elsevier; 2022. chap 435–452
• 16 Fidelman N. Benign biliary strictures: diagnostic evaluation and approaches to percutaneous treatment. Tech Vasc Interv Radiol 2015; 18 (04) 210-217
• 17 Zajko AB, Sheng R, Zetti GM, Madariaga JR, Bron KM. Transhepatic balloon dilation of biliary strictures in liver transplant patients: a 10-year experience. J Vasc Interv Radiol 1995; 6 (01) 79-83
• 18 Trambert JJ, Bron KM, Zajko AB, Starzl TE, Iwatsuki S. Percutaneous transhepatic balloon dilatation of benign biliary strictures. AJR Am J Roentgenol 1987; 149 (05) 945-948
• 19 Cantwell CP, Pena CS, Gervais DA, Hahn PF, Dawson SL, Mueller PR. Thirty years' experience with balloon dilation of benign postoperative biliary strictures: long-term outcomes. Radiology 2008; 249 (03) 1050-1057
• 20 Savader SJ, Cameron JL, Lillemoe KD, Lund GB, Mitchell SE, Venbrux AC. The biliary manometric perfusion test and clinical trial – long-term predictive value of success after treatment of bile duct strictures: ten-year experience. J Vasc Interv Radiol 1998; 9 (06) 976-985
• 21 Janssen JJ, van Delden OM, van Lienden KP. et al. Percutaneous balloon dilatation and long-term drainage as treatment of anastomotic and nonanastomotic benign biliary strictures. Cardiovasc Intervent Radiol 2014; 37 (06) 1559-1567
• 22 Saad WE, Davies MG, Saad NE. et al. Transhepatic dilation of anastomotic biliary strictures in liver transplant recipients with use of a combined cutting and conventional balloon protocol: technical safety and efficacy. J Vasc Interv Radiol 2006; 17 (05) 837-843
• 23 Ring EJ, Husted JW, Oleaga JA, Freiman DB. A multihole catheter for maintaining long term percutaneous antegrade biliary drainage. Radiology 1979; 132 (03) 752-754
• 24 Ludwig JM, Webber GR, Knechtle SJ, Spivey JR, Xing M, Kim HS. Percutaneous management of benign biliary strictures with large-bore catheters: comparison between patients with and without orthotopic liver transplantation. J Vasc Interv Radiol 2016; 27 (02) 219-225.e1
• 25 Gwon DI, Sung KB, Ko GY, Yoon HK, Lee SG. Dual catheter placement technique for treatment of biliary anastomotic strictures after liver transplantation. Liver Transpl 2011; 17 (02) 159-166
• 26 Gwon DI, Ko GY, Ko HK, Yoon HK, Sung KB. Percutaneous transhepatic treatment using retrievable covered stents in patients with benign biliary strictures: mid-term outcomes in 68 patients. Dig Dis Sci 2013; 58 (11) 3270-3279
• 27 DePietro DM, Shlansky-Goldberg RD, Soulen MC. et al. Long-term outcomes of a benign biliary stricture protocol. J Vasc Interv Radiol 2015; 26 (07) 1032-1039
• 28 Devière J, Nageshwar Reddy D, Püspök A. et al; Benign Biliary Stenoses Working Group. Successful management of benign biliary strictures with fully covered self-expanding metal stents. Gastroenterology 2014; 147 (02) 385-395 , quiz e15
• 29 Mauri G, Michelozzi C, Melchiorre F. et al. Benign biliary strictures refractory to standard bilioplasty treated using polydoxanone biodegradable biliary stents: retrospective multicentric data analysis on 107 patients. Eur Radiol 2016; 26 (11) 4057-4063
• 30 Battistel M, Senzolo M, Ferrarese A. et al. Biodegradable biliary stents for percutaneous treatment of post-liver transplantation refractory benign biliary anastomotic strictures. Cardiovasc Intervent Radiol 2020; 43 (05) 749-755
• 31 Akinci D, Unal E, Ciftci TT, Kyendyebai S, Abbasoglu O, Akhan O. Endobiliary radiofrequency ablation in the percutaneous management of refractory benign bilioenteric anastomosis strictures. AJR Am J Roentgenol 2019; 212 (03) W83-W91
• 32 Özdemir M, Küçükay F, Özdemir FAE, Acu R, Tola M, Yurdakul M. Percutaneous endobiliary radiofrequency ablation for refractory benign hepaticojejunostomy and biliary strictures. Diagn Interv Imaging 2018; 99 (09) 555-560
• 33 Husnain A, Aadam AA, Keswani R. et al. Outcomes of percutaneous endobiliary radiofrequency ablation in managing resistant benign biliary strictures: a retrospective analysis. Br J Radiol 2024;
• 34 Lou J, Hu Q, Ma T, Chen W, Wang J, Pankaj P. A novel approach with holmium laser ablation for endoscopic management of intrahepatic biliary stricture. BMC Gastroenterol 2019; 19 (01) 172
• 35 Thai Binh N, Tra My TT, Lan Oanh DT, Minh Duc N. Percutaneous transhepatic endoscopic thulium laser vaporesection for management of severe and focal benign biliary strictures. Clin Ter 2023; 174 (04) 360-364
• 36 Boeva I, Karagyozov PI, Tishkov I. Post-liver transplant biliary complications: current knowledge and therapeutic advances. World J Hepatol 2021; 13 (01) 66-79
• 37 Croome KP, Mathur AK, Aqel B. et al. Classification of distinct patterns of ischemic cholangiopathy following DCD liver transplantation: distinct clinical courses and long-term outcomes from a multicenter cohort. Transplantation 2022; 106 (06) 1206-1214
• 38 Eskander MF, Bliss LA, Yousafzai OK. et al. A nationwide assessment of outcomes after bile duct reconstruction. HPB (Oxford) 2015; 17 (09) 753-762
• 39 Mittler J, Chavin KD, Heinrich S, Kloeckner R, Zimmermann T, Lang H. Surgical duct-to-duct reconstruction: an alternative approach to late biliary anastomotic stricture after deceased donor liver transplantation. J Gastrointest Surg 2021; 25 (03) 708-712
• 40 Rayman S, Ross SB, Pattilachan TM, Christodoulou M, Rosemurgy A, Sucandy I. The robotic-assisted laparoscopic approach to biliary tract resection and reconstruction for benign indications: a single-center experience. World J Surg 2024; 48 (01) 203-210
• 41 Lillemoe HA, Lillemoe KD. Gallbladder and biliary tree: management of benign biliary strictures. In: Cameron JL, Cameron AM. eds. Current Surgical Therapy. 14th ed.. Elsevier; 2023
• 42 Huszár O, Kokas B, Mátrai P. et al. Meta-analysis of the long term success rate of different interventions in benign biliary strictures. PLoS One 2017; 12 (01) e0169618
• 43 Qureshi AA, Wehrle CJ, Ferreira-Gonzalez S. et al. Tumor organoids for primary liver cancers: a systematic review of current applications in diagnostics, disease modeling, and drug screening. JHEP Rep Innov Hepatol 2024; 6 (12) 101164
• 44 Peng WC, Kraaier LJ, Kluiver TA. Hepatocyte organoids and cell transplantation: what the future holds. Exp Mol Med 2021; 53 (10) 1512-1528