Endoscopic management of benign biliary strictures

Table 1 Etiologies of benign biliary strictures

Postsurgical

Cholecystectomy (open or laparoscopic)

Liver transplantation (i.e., anastomotic biliary stricture)

Bilio-enteric anastomosis

Sphincterotomy

Inflammatory

Chronic pancreatitis

Primary sclerosing cholangitis

Immunoglobulin G4-related cholangiopathy

Acquired immune deficiency syndrome cholangiopathy

Vasculitis

Other

Ischemia (e.g., post-liver transplantation)

Trauma

Portal biliopathy

Infection (e.g., Clonorchiasis)

Radiation injury

Idiopathic

Table 2 Commonly used guidewires in endoscopic retrograde cholangiopancreatography

	Diameter (inch)	Length (cm)	Core material	Sheath material	Tip material/properties	Tip shape	Comments	Cost ($)
Monofilament
Amplatz (Boston Scientific)	0.038	260	Stainless steel	Uncoated	Platinum	Straight	Extremely stiff	1491
Coiled
Standard (Cook Medical)	0.035	480	Stainless steel	Uncoated	Stainless steel coil	Straight	Must remove prior to sphincterotomy	90
Coated
Tracer metro direct (Cook Medical)	0.021, 0.025, 0.035	260, 480	Nitinol	Teflon	Platinum; hydrophilic (5 cm)	Straight, angled	Kink resistant, graduated endoscopic markings	196
Delta (Cook Medical)	0.025, 0.035	260	Nitinol	Polyurethane	Hydrophilic (fully)	Straight	Kink resistant, fully hydrophilic, must remove prior to sphincterotomy	151
Roadrunner (Cook Medical)	0.018	260, 480	Nitinol	Teflon	Platinum	Straight, angled	Kink resistant, must remove prior to sphincterotomy	184
Jagwire (Boston Scientific)	0.025, 0.035 0.038 (260)	260, 480	Nitinol	Endo-Glide™	Tungsten, hydrophilic (5 cm)	Straight, angled; trim, round	Kink resistant, guidewire extension (0.035, 200) available	357/box of 2
Hydra Jagwire (Boston Scientific)	0.035	260, 450	Nitinol	Endo-Glide™	Tungsten, two hydrophilic tips (5 cm, 10 cm)	Straight, angled; round	Kink resistant; two tips of varying stiffness on a single guidewire	536/box of 2
NaviPro (Boston Scientific)	0.018, 0.025, 0.035	260	Nitinol	Endo-Glide™	Hydrophilic (fully)	Straight, angled	Fully hydrophilic; 0.035-in also available in stiff	1124/box of 5
Visiglide (Olympus)	0.025, 0.035	270, 450	Superelastic alloy	Fluorine	Hydrophilic (7 cm)	Straight; angled	0.025-in has same stiffness as 0.035-in guidewire	255
XWire (ConMed)	0.025, 0.035	260, 450	Regiliant™ Nitinol	PTFE	Nitinol and Tungsten and PTFE, hydrophilic (5 cm)	Straight; angled	5 cm radiopaque tip; 0.035-in also available in stiff	460/box of 3 (260 cm) 583/box of 3 (450 cm)

Other less commonly used guidewires include Dreamwire (Boston Scientific), Savary-Gilliard (Cook Medical), Tracer Metro (Cook Medical), Fusion (Cook Medical), FXWire (ConMed), and Flex-Ez (Hobbs Medical).

¹Cost data obtained from ASGE “Guidewires for use in GI endoscopy,” Table 1[97]. PTFE: Polytetrafluoroethylene.

Table 3 Commonly used partially-covered and fully-covered self-expandable metal stents

Stent name(manufacturer)	Covering	Core material	Diameter (mm)	Length (cm)	Delivery system (Fr)	Features
Wallflex RX (Boston Scientific)	Partial	Platinol	8, 10	4, 6, 8	8.5	Closed cell construction; retrieval loop; looped and flared ends; restrainable
	Full	Platinol	8, 10	4, 6, 8	8.5
Wallstent (Boston Scientific)	Partial	Elgiloy	8, 10, 12	2, 4, 4.2, 6, 6.8, 8, 9, 9.4	6, 7, 9	Closed cell construction; restrainable
Niti-S ComVi (Taewoong Medical)	Partial	Nitinol	6, 8, 10	4, 5, 6, 7, 8, 9, 10, 12	8	Open cell; triple layered construction: mesh, membrane, and mesh to reduce migration
	Full	Nitinol	6, 8, 10	4, 5, 6, 7, 8, 9, 10, 12	8
Niti-S Kaffes (Taewoong Medical)	Full	Nitinol	6, 8, 10	4, 5, 6, 7, 8	9	Long retrieval string
Niti-S (Taewoong Medical)	Partial	Nitinol	6, 8, 10	4, 5, 6, 7, 8, 9, 10, 12	8	Retrieval string at proximal end
	Full	Nitinol	6, 8, 10	4, 5, 6, 7, 8, 9, 10, 12	8.5
Niti-S Bumpy (Taewoong Medical)	Full	Nitinol	6, 8, 10	4, 5, 6, 7, 8, 9, 10, 12	8.5	Irregular cell sizes; retrieval string at proximal end; flared ends
Nitinella Plus (ELLA-CS)	Partial	Nitinol	8, 10	4, 6, 8, 10	9	Reconstrainable; kink-resistant
	Full	Nitinol	8, 10	4, 6, 8, 10	9
Hanarostent (M.I. Tech)	Full	Nitinol	8, 10	4, 6, 8, 10	8	Larger flared ends
Micro-Tech (Micro-Tech)	Partial	Nitinol	10	4, 6, 8, 10	9
	Full	Nitinol	10	4, 6, 8	9
Gore Viabil (CONMED)	Full (with sideholes)	Nitinol	8, 10	6, 8, 10	8.5	Sideholes allow branch drainage; anchoring fins
	Full (without sideholes)	Nitinol	8, 10	6, 8, 10	8.5
Allium BIS (Allium Medical)	Full	Nitinol	8, 10	6, 8, 10, 12	10	Anchoring segment; non-shortening