Abstract
The diagnostic process for biliary strictures remains challenging in some cases. A broad differential diagnosis exists for indeterminate biliary strictures, including benign or malignant lesions. The diagnosis of indeterminate biliary strictures requires a combination of physical examination, laboratory testing, imaging modalities, and endoscopic procedures. Despite the progress of less invasive imaging modalities such as transabdominal ultrasonography, computed tomography, and magnetic resonance imaging, endoscopy plays an essential role in the accurate diagnosis, including the histological diagnosis. Imaging findings and brush cytology and/or forceps biopsy under fluoroscopic guidance with endoscopic retrograde cholangiopancreatography (ERCP) are widely used as the gold standard for the diagnosis of biliary strictures. However, ERCP cannot provide an intraluminal view of the biliary lesion, and its outcomes are not satisfactory. Recently, peroral cholangioscopy, confocal laser endomicroscopy, endoscopic ultrasound (EUS), and EUS-guided fine-needle aspiration have been reported as useful for indeterminate biliary strictures. Appropriate endoscopic modalities need to be selected according to the patient’s condition, the lesion, and the expertise of the endoscopist. The aim of this review article is to discuss the diagnostic process for indeterminate biliary strictures using endoscopy.
Highlights
Biliary strictures can lead to hepatobiliary dysfunction and eventually liver failure.They need to be appropriately treated, for example with biliary drainage and surgery; a correct diagnosis is necessary before treatment
Benign biliary strictures are caused by primary sclerosing cholangitis (PSC), IgG4-related sclerosing cholangitis, bile duct stones, infection, ischemia related to surgical interventions, or iatrogenic injury
When performing peroral cholangioscopy (POCS), we must be mindful that cholangitis could be caused by an increase in intraductal pressure due to lignant biliary strictures were 60.1% (95% CI (54.9–65.2%)) and 98.0% (95% CI (96.0–99.0%)), respectively [59]
Summary
Yuki Tanisaka * , Masafumi Mizuide, Akashi Fujita , Tomoya Ogawa, Masahiro Suzuki, Hiromune Katsuda, Youichi Saito, Kazuya Miyaguchi, Tomoaki Tashima , Yumi Mashimo and Shomei Ryozawa.
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