Approach to the patient with a biliary stricture

Biliary strictures present a diagnostic challenge and are termed indeterminate when an etiology cannot be ascertained after careful history taking, laboratory evaluation, abdominal imaging, and tissue sampling typically via Endoscopic Retrograde Cholangiography (ERCP). The implications of missing malignancy are grave; however, up to 20% of patients undergoing surgery for suspected biliary malignancy have benign pathology. The diagnostic approach revolves around a detailed history and physical examination; initially ERCP with biopsy was the only modality for securing a tissue diagnosis however with the development of Endoscopic Ultrasound (EUS) fine needle aspiration, Intraductal Ultrasound (IDUS), single operator cholangioscopy, confocal laser endomicroscopy, flow cytometry, and Fluorescent In-Situ Hybridization (FISH) analysis the diagnostic approach to biliary strictures has changed.

Source: Techniques in Gastrointestinal Endoscopy - May 30, 2016 Category: Gastroenterology Authors: Alan Brijbassie, Paul Yeaton Source Type: research