Download PDF
Digestive Disease Interventions
DOI: 10.1055/s-0045-1801881
Review Article

Surgical Management of Biliary Strictures

Nitin N. Katariya 
1   Division of Transplant Surgery, Department of Surgery, Mayo Clinic, Arizona
› Author Affiliations Funding None.
› Further Information
Also available at
    Permissions and Reprints

Abstract

Biliary strictures are a complicated entity that requires careful thought and dedicated workup to define, understand, and plan the proper management pathway. From a surgical standpoint, it can be a mixed bag at the time of presentation. Even then, the information may not be fully diagnostic and often requires multiple interventions to assess the pathology and extent of the disease. In most cases, there is concern for malignancy with no effective screening tools and small surgical windows for cure. Therefore, a dedicated multidisciplinary team of surgeons, interventional radiologists, advanced endoscopists, hepatologists, and oncologists is always necessary to work together efficiently to gather information, diagnose, prevent secondary complications, and create an effective treatment plan with aligned goals of care.

Keywords

biliary strictures - cholangiocarcinoma - biliary tree


Publication History

Received: 17 December 2024

Accepted: 24 December 2024

Article published online:
11 March 2025

© 2025. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

  • 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
    CrossrefPubMedSearch in Google Scholar
  • 2 Banales JM, Marin JJG, Lamarca A. et al. Cholangiocarcinoma 2020: the next horizon in mechanisms and management. Nat Rev Gastroenterol Hepatol 2020; 17 (09) 557-588
    CrossrefPubMedSearch in Google Scholar
  • 3 Bowlus CL, Olson KA, Gershwin ME. Evaluation of indeterminate biliary strictures. Nat Rev Gastroenterol Hepatol 2016; 13 (01) 28-37
    CrossrefPubMedSearch in Google Scholar
  • 4 Naitoh I, Nakazawa T. Classification and diagnostic criteria for IgG4-related sclerosing cholangitis. Gut Liver 2022; 16 (01) 28-36
    CrossrefPubMedSearch in Google Scholar
  • 5 Silveira MG, Lindor KD. Clinical features and management of primary sclerosing cholangitis. World J Gastroenterol 2008; 14 (21) 3338-3349
    CrossrefPubMedSearch in Google Scholar
  • 6 Dumonceau JM, Delhaye M, Charette N, Farina A. Challenging biliary strictures: pathophysiological features, differential diagnosis, diagnostic algorithms, and new clinically relevant biomarkers - part 1. Therap Adv Gastroenterol 2020; 13: 1756284820927292
    CrossrefPubMedSearch in Google Scholar
  • 7 Singhi AD, Slivka A. Evaluation of indeterminate biliary strictures: is it time to FISH or cut bait?. Gastrointest Endosc 2016; 83 (06) 1236-1238
    CrossrefPubMedSearch in Google Scholar
  • 8 Sharma S, Gurakar A, Jabbour N. Biliary strictures following liver transplantation: past, present and preventive strategies. Liver Transpl 2008; 14 (06) 759-769
    CrossrefPubMedSearch in Google Scholar
  • 9 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
    CrossrefPubMedSearch in Google Scholar
  • 10 Achurra P, Fernandes E, O'Kane G, Grant R, Cattral M, Sapisochin G. Liver transplantation for intrahepatic cholangiocarcinoma: who, when and how. Curr Opin Organ Transplant 2024; 29 (02) 161-171
    CrossrefPubMedSearch in Google Scholar
  • 11 OPTN. National Liver Review Board (NLRB) Updates Related to Transplant Oncology. 2024 [cited June 2024]; National Liver Review Board (NLRB) Updates Related to Transplant Oncology]. Accessed January 8, 2025 at: https://hrsa.unos.org/media/ymapp25j/liver_nlrb_june-2024_pn.pdf
    PubMed
  • 12 Heimbach JK, Gores GJ, Haddock MG. et al. Liver transplantation for unresectable perihilar cholangiocarcinoma. Semin Liver Dis 2004; 24 (02) 201-207
    Thieme ConnectPubMedSearch in Google Scholar
  • 13 Schreuder AM, Engelsman AF, van Roessel S. et al. Treatment of mid-bile duct carcinoma: local resection or pancreatoduodenectomy?. Eur J Surg Oncol 2019; 45 (11) 2180-2187
    CrossrefPubMedSearch in Google Scholar
  • 14 Riaz A, Entezari P, Ganger D. et al. Percutaneous access of the modified Hutson loop for retrograde cholangiography, endoscopy, and biliary interventions. J Vasc Interv Radiol 2020; 31 (12) 2113-2120.e1
    CrossrefPubMedSearch in Google Scholar
  • 15 Schreuder AM, Franken LC, van Dieren S, Besselink MG, Busch OR, van Gulik TM. Choledochoduodenostomy versus hepaticojejunostomy - a matched case-control analysis. HPB (Oxford) 2021; 23 (04) 560-565
    CrossrefPubMedSearch in Google Scholar
  • 16 Takenaka M, Lee TH. Role of radiofrequency ablation in advanced malignant hilar biliary obstruction. Clin Endosc 2023; 56 (02) 155-163
    CrossrefPubMedSearch in Google Scholar
  • 17 Cheon YK. Recent advances of photodynamic therapy for biliary tract cancer. Int J Gastrointest Intervent 2021; 10 (03) 96-100
    CrossrefPubMedSearch in Google Scholar