Editorial
Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Feb 21, 2017; 23(7): 1119-1124
Published online Feb 21, 2017. doi: 10.3748/wjg.v23.i7.1119
Common controversies in management of biliary strictures
Mansour A Parsi
Mansour A Parsi, Center for Endoscopy and Pancreatobiliary Disorders, Department of Gastroenterology and Hepatology, Cleveland Clinic, Cleveland, OH 44195, United States
Author contributions: Parsi MA solely designed, wrote and edited the manuscript.
Conflict-of-interest statement: No conflicts of interest related to this manuscript.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Mansour A Parsi, MD, MPH, Center for Endoscopy and Pancreatobiliary Disorders, Department of Gastroenterology and Hepatology, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, United States. parsim@ccf.org
Telephone: +1-216-4454880 Fax: +1-216-4446284
Received: September 14, 2016
Peer-review started: September 16, 2016
First decision: November 21, 2016
Revised: December 10, 2016
Accepted: January 18, 2017
Article in press: January 18, 2017
Published online: February 21, 2017
Processing time: 159 Days and 13.4 Hours
Core Tip

Core tip: Based on available evidence preoperative biliary drainage is not routinely indicated in resectable malignant strictures. However, it is appropriate in acute cholangitis, in severely symptomatic patients and in those with delayed surgery. In patients with unresectable hilar stricture, cross-sectional imaging is advised prior to attempt at palliative drainage. In such patients unilateral stenting during endoscopic retrograde cholangiopancreatography is adequate in most cases. Routine stenting of dominant strictures in primary sclerosing cholangitis patients is not recommended. Stenting of dominant strictures is appropriate if there is poor drainage of contrast after dilatation or concern for collapse of the bile duct compromising biliary drainage.