RSS-Feed abonnieren
DOI: 10.1055/s-0041-1731087
Percutaneous Management of Benign Biliary Strictures
![](https://www.thieme-connect.de/media/sir/202103/lookinside/thumbnails/10-1055-s-0041-1731087_001290-1.jpg)
Abstract
Benign biliary strictures are often due to a variety of etiologies, most of which are iatrogenic. Clinical presentation can vary from asymptomatic disease with elevated liver enzymes to obstructive jaundice and recurrent cholangitis. Diagnostic imaging methods, such as ultrasound, multidetector computed tomography, and magnetic resonance imaging (cholangiopancreatography), are used to identify stricture location, extent, and possible source of biliary obstruction. The management of benign biliary strictures requires a multidisciplinary team approach and include endoscopic, percutaneous, and surgical interventions. Percutaneous biliary interventions provide an alternative diagnostic and therapeutic approach, especially in patients who are not amenable to endoscopic evaluation. This review provides an overview of benign biliary strictures and percutaneous management by interventional radiologists. Diagnostic evaluation with percutaneous transhepatic cholangiography and treatment options, including biliary drainage, balloon dilation, retrievable/biodegradable stents, and other innovative minimally invasive options, are discussed.
Keywords
interventional radiology - benign biliary strictures - percutaneous management - cholangioplasty - biliary stentPublikationsverlauf
Artikel online veröffentlicht:
10. August 2021
© 2021. 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
- 2 Bowlus CL, Olson KA, Gershwin ME. Evaluation of indeterminate biliary strictures. Nat Rev Gastroenterol Hepatol 2016; 13 (01) 28-37
- 3 Mariani A, Segato S, Anderloni A. et al. Prospective evaluation of ERCP performance in an Italian regional database study. Dig Liver Dis 2019; 51 (07) 978-984
- 4 Ekkelenkamp VE, de Man RA, Ter Borg F. et al. Prospective evaluation of ERCP performance: results of a nationwide quality registry. Endoscopy 2015; 47 (06) 503-507
- 5 Dumonceau JM, Tringali A, Papanikolaou IS. et al. Endoscopic biliary stenting: indications, choice of stents, and results: European Society of Gastrointestinal Endoscopy (ESGE) Clinical Guideline - Updated October 2017. Endoscopy 2018; 50 (09) 910-930
- 6 Judah JR, Draganov PV. Endoscopic therapy of benign biliary strictures. World J Gastroenterol 2007; 13 (26) 3531-3539
- 7 Koide H, Sato K, Fukusato T. et al. Spontaneous regression of hepatic inflammatory pseudotumor with primary biliary cirrhosis: case report and literature review. World J Gastroenterol 2006; 12 (10) 1645-1648
- 8 Op den Dries S, Sutton ME, Lisman T, Porte RJ. Protection of bile ducts in liver transplantation: looking beyond ischemia. Transplantation 2011; 92 (04) 373-379
- 9 Bismuth H, Majno PE. Biliary strictures: classification based on the principles of surgical treatment. World J Surg 2001; 25 (10) 1241-1244
- 10 Strasberg SM, Hertl M, Soper NJ. An analysis of the problem of biliary injury during laparoscopic cholecystectomy. J Am Coll Surg 1995; 180 (01) 101-125
- 11 Kapoor BS, Mauri G, Lorenz JM. Management of biliary strictures: state-of-the-art review. Radiology 2018; 289 (03) 590-603
- 12 Fidelman N. Benign biliary strictures: diagnostic evaluation and approaches to percutaneous treatment. Tech Vasc Interv Radiol 2015; 18 (04) 210-217
- 13 Blackbourne LH, Earnhardt RC, Sistrom CL, Abbitt P, Jones RS. The sensitivity and role of ultrasound in the evaluation of biliary obstruction. Am Surg 1994; 60 (09) 683-690
- 14 Choi SH, Han JK, Lee JM. et al. Differentiating malignant from benign common bile duct stricture with multiphasic helical CT. Radiology 2005; 236 (01) 178-183
- 15 Yoon KH, Ha HK, Kim MH. et al. Biliary stricture caused by blunt abdominal trauma: clinical and radiologic features in five patients. Radiology 1998; 207 (03) 737-741
- 16 Griffin N, Charles-Edwards G, Grant LA. Magnetic resonance cholangiopancreatography: the ABC of MRCP. Insights Imaging 2012; 3 (01) 11-21
- 17 Suthar M, Purohit S, Bhargav V, Goyal P. Role of MRCP in differentiation of benign and malignant causes of biliary obstruction. J Clin Diagn Res 2015; 9 (11) TC08-TC12
- 18 Soto JA, Alvarez O, Lopera JE, Múnera F, Restrepo JC, Correa G. Biliary obstruction: findings at MR cholangiography and cross-sectional MR imaging. Radiographics 2000; 20 (02) 353-366
- 19 Lee SS, Kim MH, Lee SK. et al. MR cholangiography versus cholangioscopy for evaluation of longitudinal extension of hilar cholangiocarcinoma. Gastrointest Endosc 2002; 56 (01) 25-32
- 20 Fulcher AS, Turner MA. HASTE MR cholangiography in the evaluation of hilar cholangiocarcinoma. AJR Am J Roentgenol 1997; 169 (06) 1501-1505
- 21 Materne R, Van Beers BE, Gigot JF. et al. Extrahepatic biliary obstruction: magnetic resonance imaging compared with endoscopic ultrasonography. Endoscopy 2000; 32 (01) 3-9
- 22 Heinzow HS, Kammerer S, Rammes C, Wessling J, Domagk D, Meister T. Comparative analysis of ERCP, IDUS, EUS and CT in predicting malignant bile duct strictures. World J Gastroenterol 2014; 20 (30) 10495-10503
- 23 Funaki B. Percutaneous biliary drainage. Semin Intervent Radiol 2007; 24 (02) 268-271
- 24 Ahmed O, Mathevosian S, Arslan B. Biliary interventions: tools and techniques of the trade, access, cholangiography, biopsy, cholangioscopy, cholangioplasty, stenting, stone extraction, and brachytherapy. Semin Intervent Radiol 2016; 33 (04) 283-290
- 25 Altman A, Zangan SM. Benign biliary strictures. Semin Intervent Radiol 2016; 33 (04) 297-306
- 26 Ahmed S, Schlachter TR, Hong K. Percutaneous transhepatic cholangioscopy. Tech Vasc Interv Radiol 2015; 18 (04) 201-209
- 27 Qin LX, Tang ZY. Hepatocellular carcinoma with obstructive jaundice: diagnosis, treatment and prognosis. World J Gastroenterol 2003; 9 (03) 385-391
- 28 Ponchon T, Genin G, Mitchell R. et al. Methods, indications, and results of percutaneous choledochoscopy. A series of 161 procedures. Ann Surg 1996; 223 (01) 26-36
- 29 Wieman TJ, Corey TS, Shively E. Postoperative percutaneous choledochoscopy. Am Surg 1989; 55 (02) 97-99
- 30 Zhuo H, Chen Z, Lin R. et al. Percutaneous transhepatic choledochoscopic lithotomy (PTCSL) is effective for the treatment of intrahepatic and extrahepatic choledocholithiasis. Surg Laparosc Endosc Percutan Tech 2020; 31 (03) 326-330
- 31 Hazey JW, McCreary M, Guy G, Melvin WS. Efficacy of percutaneous treatment of biliary tract calculi using the holmium:YAG laser. Surg Endosc 2007; 21 (07) 1180-1183
- 32 Ma MX, Jayasekeran V, Chong AK. Benign biliary strictures: prevalence, impact, and management strategies. Clin Exp Gastroenterol 2019; 12: 83-92
- 33 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
- 34 Tocchi A, Mazzoni G, Liotta G. et al. Management of benign biliary strictures: biliary enteric anastomosis vs endoscopic stenting. Arch Surg 2000; 135 (02) 153-157
- 35 Genest JF, Nanos E, Grundfest-Broniatowski S, Vogt D, Hermann RE. Benign biliary strictures: an analytic review (1970 to 1984). Surgery 1986; 99 (04) 409-413
- 36 Röthlin MA, Löpfe M, Schlumpf R, Largiadèr F. Long-term results of hepaticojejunostomy for benign lesions of the bile ducts. Am J Surg 1998; 175 (01) 22-26
- 37 Schumacher B, Othman T, Jansen M, Preiss C, Neuhaus H. Long-term follow-up of percutaneous transhepatic therapy (PTT) in patients with definite benign anastomotic strictures after hepaticojejunostomy. Endoscopy 2001; 33 (05) 409-415
- 38 Way LW, Bernhoft RA, Thomas MJ. Biliary stricture. Surg Clin North Am 1981; 61 (04) 963-972
- 39 Shanbhogue AK, Tirumani SH, Prasad SR, Fasih N, McInnes M. Benign biliary strictures: a current comprehensive clinical and imaging review. AJR Am J Roentgenol 2011; 197 (02) W295-W306
- 40 De Robertis R, Contro A, Zamboni G, Mansueto G. Totally percutaneous rendezvous techniques for the treatment of bile strictures and leakages. J Vasc Interv Radiol 2014; 25 (04) 650-654
- 41 Habibollahi P, Benjamin JL, Bai HX, Dagli MS, Shlansky-Goldberg RD. Percutaneous fluoroscopic-guided creation of neoanastomosis for the treatment of biliary occlusions. Cardiovasc Intervent Radiol 2020; 43 (11) 1671-1678
- 42 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
- 43 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
- 44 Weber A, Rosca B, Neu B. et al. Long-term follow-up of percutaneous transhepatic biliary drainage (PTBD) in patients with benign bilioenterostomy stricture. Endoscopy 2009; 41 (04) 323-328
- 45 Eickhoff A, Schilling D, Jakobs R. et al. Long-term outcome of percutaneous transhepatic drainage for benign bile duct stenoses. Rocz Akad Med Bialymst 2005; 50: 155-160
- 46 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
- 47 Park SJ, Chung HH, Lee SH. et al. Long-term balloon indwelling technique for the treatment of single benign biliary stricture. Diagn Interv Radiol 2019; 25 (01) 90-94
- 48 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
- 49 Krokidis M, Orgera G, Rossi M, Matteoli M, Hatzidakis A. Interventional radiology in the management of benign biliary stenoses, biliary leaks and fistulas: a pictorial review. Insights Imaging 2013; 4 (01) 77-84
- 50 Köcher M, Cerná M, Havlík R, Král V, Gryga A, Duda M. Percutaneous treatment of benign bile duct strictures. Eur J Radiol 2007; 62 (02) 170-174
- 51 Glas L, Courbière M, Ficarelli S, Milot L, Mennesson N, Pilleul F. Long-term outcome of percutaneous transhepatic therapy for benign bilioenteric anastomotic strictures. J Vasc Interv Radiol 2008; 19 (09) 1336-1343
- 52 Bonnel DH, Fingerhut AL. Percutaneous transhepatic balloon dilatation of benign bilioenteric strictures: long-term results in 110 patients. Am J Surg 2012; 203 (06) 675-683
- 53 Kucukay F, Okten RS, Yurdakul M. et al. Long-term results of percutaneous biliary balloon dilation treatment for benign hepaticojejunostomy strictures: are repeated balloon dilations necessary?. J Vasc Interv Radiol 2012; 23 (10) 1347-1355 , quiz 1357
- 54 Ko GY, Sung KB, Yoon HK, Kim KR, Gwon DI, Lee SG. Percutaneous transhepatic treatment of hepaticojejunal anastomotic biliary strictures after living donor liver transplantation. Liver Transpl 2008; 14 (09) 1323-1332
- 55 Vos PM, van Beek EJ, Smits NJ, Rauws EA, Gouma DJ, Reeders JW. Percutaneous balloon dilatation for benign hepaticojejunostomy strictures. Abdom Imaging 2000; 25 (02) 134-138
- 56 Atar E, Bachar GN, Bartal G. et al. Use of peripheral cutting balloon in the management of resistant benign ureteral and biliary strictures. J Vasc Interv Radiol 2005; 16 (2, Pt 1): 241-245
- 57 Saad WE, Saad NE, Davies MG. et al. Transhepatic balloon dilation of anastomotic biliary strictures in liver transplant recipients: the significance of a patent hepatic artery. J Vasc Interv Radiol 2005; 16 (09) 1221-1228
- 58 Siriwardana HP, Siriwardena AK. Systematic appraisal of the role of metallic endobiliary stents in the treatment of benign bile duct stricture. Ann Surg 2005; 242 (01) 10-19
- 59 Kim JH, Gwon DI, Ko GY. et al. Temporary placement of retrievable fully covered metallic stents versus percutaneous balloon dilation in the treatment of benign biliary strictures. J Vasc Interv Radiol 2011; 22 (06) 893-899
- 60 Schmidt A, Pickartz T, Lerch MM. et al. Effective treatment of benign biliary strictures with a removable, fully covered, self-expandable metal stent: a prospective, multicenter European study. United European Gastroenterol J 2017; 5 (03) 398-407
- 61 Yun G, Yoon CJ, Seong NJ. Percutaneous treatment of benign bilioenteric anastomotic strictures: temporary covered stent placement versus balloon dilatation. Eur Radiol 2019; 29 (05) 2690-2697
- 62 Ye P, Zeng Q, Miao H, Pang H, Chen Y. Percutaneous treatment of benign biliary anastomotic strictures: retrievable covered self-expandable metal stent with fixation string versus large-bore catheters. J Vasc Interv Radiol 2021; 32 (01) 113-120
- 63 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
- 64 Costamagna G, Pandolfi M, Mutignani M, Spada C, Perri V. Long-term results of endoscopic management of postoperative bile duct strictures with increasing numbers of stents. Gastrointest Endosc 2001; 54 (02) 162-168
- 65 Draganov P, Hoffman B, Marsh W, Cotton P, Cunningham J. Long-term outcome in patients with benign biliary strictures treated endoscopically with multiple stents. Gastrointest Endosc 2002; 55 (06) 680-686
- 66 Coté GA, Slivka A, Tarnasky P. et al. Effect of covered metallic stents compared with plastic stents on benign biliary stricture resolution: a randomized clinical trial. JAMA 2016; 315 (12) 1250-1257
- 67 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
- 68 Jang SI, Choi J, Lee DK. Magnetic compression anastomosis for treatment of benign biliary stricture. Dig Endosc 2015; 27 (02) 239-249
- 69 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
- 70 De Gregorio MA, Criado E, Guirola JA. et al; Spanish Group BiELLA (SERVEI). Absorbable stents for treatment of benign biliary strictures: long-term follow-up in the prospective Spanish registry. Eur Radiol 2020; 30 (08) 4486-4495
- 71 Jang SI, Kim JH, Won JY. et al. Magnetic compression anastomosis is useful in biliary anastomotic strictures after living donor liver transplantation. Gastrointest Endosc 2011; 74 (05) 1040-1048
- 72 Parlak E, Koksal AS, Kucukay F, Eminler AT, Toka B, Uslan MI. A novel technique for the endoscopic treatment of complete biliary anastomosis obstructions after liver transplantation: through-the-scope magnetic compression anastomosis. Gastrointest Endosc 2017; 85 (04) 841-847
- 73 Li Y, Sun H, Yan X. et al. Magnetic compression anastomosis for the treatment of benign biliary strictures: a clinical study from China. Surg Endosc 2020; 34 (06) 2541-2550
- 74 Avaliani M, Chigogidze N, Nechipai A, Dolgushin B. Magnetic compression biliary-enteric anastomosis for palliation of obstructive jaundice: initial clinical results. J Vasc Interv Radiol 2009; 20 (05) 614-623
- 75 Li TF, Huang GH, Li Z. et al. Percutaneous transhepatic cholangiography and intraductal radiofrequency ablation combined with biliary stent placement for malignant biliary obstruction. J Vasc Interv Radiol 2015; 26 (05) 715-721
- 76 Mizandari M, Pai M, Xi F. et al. Percutaneous intraductal radiofrequency ablation is a safe treatment for malignant biliary obstruction: feasibility and early results. Cardiovasc Intervent Radiol 2013; 36 (03) 814-819
- 77 Pai M, Valek V, Tomas A. et al. Percutaneous intraductal radiofrequency ablation for clearance of occluded metal stent in malignant biliary obstruction: feasibility and early results. Cardiovasc Intervent Radiol 2014; 37 (01) 235-240
- 78 Hu B, Gao DJ, Wu J, Wang TT, Yang XM, Ye X. Intraductal radiofrequency ablation for refractory benign biliary stricture: pilot feasibility study. Dig Endosc 2014; 26 (04) 581-585
- 79 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
- 80 Winick AB, Waybill PN, Venbrux AC. Complications of percutaneous transhepatic biliary interventions. Tech Vasc Interv Radiol 2001; 4 (03) 200-206
- 81 Burke DR, Lewis CA, Cardella JF. et al; Society of Interventional Radiology Standards of Practice Committee. Quality improvement guidelines for percutaneous transhepatic cholangiography and biliary drainage. J Vasc Interv Radiol 2003; 14 (9, Pt 2): S243-S246