Editorial
Copyright ©2007 Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jul 14, 2007; 13(26): 3531-3539
Published online Jul 14, 2007. doi: 10.3748/wjg.v13.i26.3531
Endoscopic therapy of benign biliary strictures
Joel R Judah, Peter V Draganov
Joel R Judah, Peter V Draganov, University of Florida, Division of Gastroenterology, Hepatology and Nutrition, Gainesville, Florida, United States
Author contributions: All authors contributed equally to the work.
Correspondence to: Peter Draganov, MD, Division of Gastroenterology, Hepatology and Nutrition, PO Box 100214, University of Florida, Gainesville, FL 32610-0214, United States. dragapv@medicine.ufl.edu
Telephone: +1-352-3922877 Fax: +1-352-3923618
Received: April 23, 2007
Revised: April 25, 2007
Accepted: May 21, 2007
Published online: July 14, 2007
Abstract

Benign biliary strictures are being increasingly treated with endoscopic techniques. The benign nature of the stricture should be first confirmed in order to ensure appropriate therapy. Surgery has been the traditional treatment, but there is increasing desire for minimally invasive endoscopic therapy. At present, endoscopy has become the first line approach for the therapy of post-liver transplant anastomotic strictures and distal (Bismuth Iand II) post-operative strictures. Strictures related to chronic pancreatitis have proven more difficult to treat, and endoscopic therapy is reserved for patients who are not surgical candidates. The preferred endoscopic approach is aggressive treatment with gradual dilation of the stricture and insertion of multiple plastic stents. The use of uncovered self expandable metal stents should be discouraged due to poor long-term results. Treatment with covered metal stents or bioabsorbable stents warrants further evaluation. This area of therapeutic endoscopy provides an ongoing opportunity for fresh research and innovation.

Keywords: Biliary stricture; Endoscopy; Biliary stent; Pancreatitis; Liver transplant; Anastomotic stricture