What Is a Biliary Stricture?

Biliary stricture is caused by bile duct injury, recurrent cholangitis, or congenital scarring of the bile duct. Biliary duct stenosis can be stimulated by iatrogenic injury, abdominal trauma, gallbladder stones, bile duct stones, and bile duct inflammation, resulting in fibrous tissue hyperplasia of the bile duct wall, thickening of the tube wall, and narrowing of the bile duct lumen. Clinical manifestations include abdominal pain, chills, high fever, and intermittent jaundice. Early antibiotic treatment is feasible, but surgical treatment is the fundamental treatment of this disease.

Basic Information

Visiting department

Gastroenterology, General Surgery

Common locations

bile duct

Common causes

Caused by bile duct injury, recurrent cholangitis, or congenital scarring of the bile ducts

Common symptoms

Abdominal pain, chills, high fever, intermittent jaundice, etc.

Causes of bile duct stricture

1. Lesions of the bile duct itself

( 1) Congenital anomalies

(2) Inflammation is common in hepatobiliary wall ulcers caused by bile duct stones, mainly in the hilar and intrahepatic bile ducts.

(3) Most of the injuries are iatrogenic.

(4) The vast majority of tumors are bile duct cancer.

(5) In addition to the bile duct anastomosis technique after liver transplantation , the main reason is that the blood supply to the bile duct is insufficient, which is related to the long cold ischemia time at the time of transplantation.

2. Lesions outside the bile duct

(1) The distal part of the pancreatic bile duct is closely behind the pancreatic head, so in addition to pancreatic cancer that can infiltrate the bile duct, chronic pancreatitis, especially autoimmune pancreatitis, can sometimes involve the distal part of the bile duct, causing poor bile drainage.

(2) Swelling of the liver and duodenal lymph nodes. Gastric cancer and pancreatic head cancer can be transferred to the lymph nodes in the hepatoduodenal ligament, thereby compressing the extrahepatic bile duct.

(3) Gallbladder cancer invades the hilar area and hepatoduodenal ligament.

Clinical manifestations of bile duct stricture

Traumatic biliary stricture has a history of biliary tract surgery. Patients occasionally have cholangitis several months or 1 to 2 years after cholecystectomy. They have abdominal pain, chills, high fever, and intermittent jaundice. The intermittent period is gradually shortened and the symptoms are getting worse. A few patients present with painless jaundice or have developed biliary cirrhosis with portal hypertension.

Biliary stricture examination

1.B ultrasound

Ultrasound is the first choice for preoperative imaging, especially for patients with jaundice as the first symptom, and it is more sensitive to intrahepatic and extrahepatic bile duct dilatation or bile duct stones.

2. Retrograde cholangiopancreatography (ERCP )

ERCP is considered to be the gold standard for the diagnosis of bile duct diseases. It can clearly show the location and extent of bile duct stenosis, the degree of bile duct dilatation above the stenosed segment, and stones.

3.CT inspection

CT scan can clearly show biliary dilatation and gas accumulation, and has a good diagnostic effect on bile duct dilatation and cholangitis.

4. Intravenous cholangiography

Can roughly show the rough condition of the bile duct. A common feature of the image is dilatation of the bile ducts above the stenosed segment. The image of intrahepatic bile duct stones shows uneven distribution of contrast agent, slow, light, and narrow development; alternate expansion, and sometimes the distribution of contrast agent is plaque-shaped.

Diagnosis of bile duct stricture

According to the history and clinical symptoms such as abdominal pain, chills, high fever, intermittent jaundice, etc., combined with imaging examination can help diagnosis.

Biliary stricture

General treatment

Effectively control biliary tract infections, provide a high-sugar and high-protein diet to improve nutritional status; supplement energy mixtures and vitamins K, B, and C to maintain liver and systemic immune systems.

2. Surgical treatment

Surgical treatment is the first choice for this disease. The principle of treatment is to remove narrow scar lesions, repair and reconstruct the biliary tract. The specific surgical method depends on the time of biliary obstruction, the type and degree of stenosis, the pathological state and the general situation of the patient. The mucosal-mucosal hepatic-jejunal Roux-en-Y anastomosis has become the "gold standard" for the treatment of traumatic bile duct stenosis, and it can obtain good curative effects for most stenoses.