Bile duct stricture
Bile duct stricture
Description, Causes and Risk Factors:
Bile duct strictures are narrowed areas of the bile ducts that can be either benign or malignant (cancerous). People with bile duct strictures often experience symptoms including jaundice or pain, or have abnormal blood tests.
Bile duct strictures may be associated with active diseases or may be scarring left over from the passage of a gallstone or from a previous surgery. Sometimes the bile ducts are narrowed because they are pressed upon from the outside, such as with diseases of the liver or pancreas or some tumors.
However, not all bile duct strictures are benign. Pancreatic cancer is the most common cause of malignant bile duct strictures. Most of these patients die of complications of tumor invasion and metastasis rather than from the bile duct stricture per se. Nonetheless, both benign and malignant bile duct strictures can be associated with distressing symptoms and excessive morbidity.
Depending on the nature of the insult, bile duct strictures can be single or multiple. Atrophy of the hepatic segment or lobe drained by the involved bile ducts, associated with hypertrophy of the unaffected segments can occur especially with chronic high-grade strictures. These changes can eventually progress to secondary biliary cirrhosis and portal hypertension. Malignant strictures usually are the result of either a primary bile duct cancer (i.e., causing a narrowing of the bile duct lumen and obstructing the flow of bile) or extrinsic compression of the bile ducts by a neoplasm in an adjacent organ, such as the gallbladder, pancreas, or liver.
Although quite uncommon, the exact prevalence of bile duct strictures is unknown. One major category of bile duct strictures is postoperative bile duct stricture, which usually occurs as a result of a technical mishap during cholecystectomy, causing bile duct injury. Data from many large series of patients in the US have revealed that the incidence rate of major bile duct injury is 0.2-0.3% after open cholecystectomy and 0.4-0.6% after a laparoscopic cholecystectomy.
Common symptoms and signs of a bile duct stricture include:
Itching (a common symptom).
Yellow skin or eyes (from the buildup of bilirubin, a waste product).
Loss of appetite.
Abdominal pain on the right side of the body (where the liver and gallbladder are located).
The diagnosis of a bile duct stricture is made with ultrasound, CT or MRI scan, or endoscopic techniques such as ERCP (endoscopic retrograde cholangiopancreatography) or endoscopic ultrasound.
Other Tests: Magnetic resonance cholangiopancreatography (MRCP) and percutaneous transhepatic cholangiogram (PTCA).
The following blood tests can help reveal a problem with the Biliary system.
Bilirubin level is higher than normal.
Alkaline phosphatase (ALP) is higher than normal.
This condition may also alter the results of the following tests:
Prothrombin time (PT).
Once a bile duct stricture has been diagnosed, treatment will depend on the severity of symptoms and the degree of narrowing within the duct.
Endoscopic therapy: A bile duct stricture is commonly treated by placing a small stent (a hollow tube) within the bile duct to keep it open. This procedure can be performed at the time of diagnosis with miniaturized surgical instruments inserted through the ERCP endoscope. If the narrowing or stricture completely blocks the bile duct - and if it is amenable to dilation or enlargement - it can be widened first with a procedure called balloon dilation. A balloon on the tip of a catheter is passed through the ERCP endoscope and is inflated at the site of the stricture, enlarging the blocked duct. A stent, also passed through the ERCP endoscope, is then placed within the duct and opened.
Percutaneous therapy: When an ERCP procedure is not the best option for the patient, a percutaneous (through the skin) procedure to dilate a stricture and place a stent can be done instead.
Surgical therapy: Surgical treatment is recommended when endoscopic therapy is not successful or if the bile duct stricture cannot be treated by endoscopic or percutaneous means. During surgery, our liver, pancreas and biliary surgical team remove the stricture and connect the bile duct to the small intestine. This open surgical procedure is performed in the operating room under a general anesthetic.
Medical Therapy: Patients who have inflammation or infection (cholangitis) within a bile duct are treated first with antibiotics. The majority of patients respond to this Medical therapy, during which time a definitive determination can be made for endoscopic or surgical therapy.
NOTE: The above information is educational purpose. The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition.
DISCLAIMER: This information should not substitute for seeking responsible, professional medical care.
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