Endoscopic management of hilar biliary strictures

Table 1 Etiology of benign and malignant hilar strictures[1]

Malignant hilar strictures

Primary tumors (cholangiocarcinoma)

Local extension (gallbladder cancer, hepatocellular carcinoma, and pancreatic cancer)

Lymph node metastases (Breast, colon, stomach, ovaries, lymphoma, and melanoma)

Benign hilar strictures

Postoperative injuries (cholecystectomy, liver transplantation, liver resection, and biliodigestive anastomosis)

Primary sclerosing cholangitis

Others (stone disease, follicular cholangitis, parasite infection, granular cell tumor, chronic fibroinflammatory process, compression from portal cavernomatosis, granulomatous process, and lymphoplasmacyticscleros ingpancreatitis/cholangitis)

Table 2 Brush cytology in malignant biliary obstuction

No.	Ref.	No. of patients	Sensitivity (%)	Specificity (%)
1	Venu et al[15]	53	70	100
2	Foutch et al[16]	24	60	100
3	Ferrari Júnior et al[17]	70	56	100
5	Singh et al[18]	30	37	100

Table 3 Bismuth-lazorthes Classification of postsurgical benign biliary strictures

Type I: Common hepatic or main bile duct stump ≥ 2 cm

Type II: Common hepatic duct stump < 2 cm

Type III: Hilar stricture- ceiling of the biliary confluence is intact, right and left ductal system communicate

Type IV: Ceiling of the confluence is destroyed, bile ducts are separated

Type V: Type I, II or III plus stricture of an isolated right duct

Table 4 Bismuth classification of malignant hilar block[31]

Type I: Obstruction within 1 cm of bifurcation but confluence patent

Type II: Obstruction limited to confluence

Type III: Obstruction at confluence with proximal extension to right or left side

Type IV: Obstruction involving bilateral secondary or tertiary branches or multifocal strictures