Role of endoscopic retrograde cholangiopancreatography in the management of benign biliary strictures: What’s new?

Abstract

Benign biliary strictures comprise a heterogeneous group of diseases. The most common strictures amenable to endoscopic treatment are post-cholecystectomy, post-liver transplantation, related to primary sclerosing cholangitis and to chronic pancreatitis. Endoscopic treatment of benign biliary strictures is widely used as first line therapy, since it is effective, safe, noninvasive and repeatable. Endoscopic techniques currently used are dilation, multiple plastic stents insertion and fully covered self-expandable metal stents. The main indication for dilation alone is primary sclerosing cholangitis related strictures. In the vast majority of the remaining cases, temporary placement of multiple plastic stents with/without dilation is considered the treatment of choice. Although this approach is effective, it requires multiple endoscopic sessions due to the short duration of stent patency. Fully covered self-expandable metal stents appear as a good alternative to plastic stents, since they have an increased radial diameter, longer stent patency, easier insertion technique and similar efficacy. Recent advances in endoscopic technique and various devices have allowed successful treatment in most cases. The development of novel endoscopic techniques and devices is still ongoing.

Keywords: Benign biliary strictures, Bile duct stricture, Endoscopic retrograde cholangiopancreatography, Stents, Cholecystectomy, Liver transplantation, Primary sclerosing cholangitis, Chronic pancreatitis

Core tip: Endoscopic treatment of benign biliary strictures has been evolved in the last decades and is widely considered as first line therapy. Among endoscopic techniques, multiple plastic stents placement is an effective method but requires multiple endoscopic sessions. Fully covered self-expandable metal stents appear as a reasonable alternative due to their larger lumen and longer patency. Emergent data proved their efficacy, their low complications rate and cost-effectiveness. We herein discuss the endoscopic management of benign biliary strictures and focus on the outcomes, advantages and disadvantages of each endoscopic technique.