Endoscopy 2025; 57(02): 166-185
DOI: 10.1055/a-2481-7048
Guideline

Diagnostic work-up of bile duct strictures: European Society of Gastrointestinal Endoscopy (ESGE) Guideline

1   Experimental Medicine, Università del Salento, Lecce, Italy (Ringgold ID: RIN18976)
2   Clinical Effectiveness Research Group, Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
,
Stefano Francesco Crinò
3   Gastroenterology, University of Verona, Verona, Italy
,
Paraskevas Gkolfakis
4   Gastroenterology, "Konstantopoulio-Patision" General Hospital of Nea Ionia, Athens, Greece
,
Marco Spadaccini
5   Endoscopy Unit, Istituto Clinico Humanitas, Rozzano, Italy (Ringgold ID: RIN9268)
,
Marianna Arvanitakis
6   Gastroenterology, Digestive Oncology and Hepatopancreatology, HUB Hôpital Erasme, Brussels, Belgium
,
7   Internal Medicine, Evangelisches Krankenhaus Düsseldorf, Düsseldorf, Germany
,
8   Gastroenterology and Hepatology, Imelda Hospital, Bonheiden, Belgium (Ringgold ID: RIN81874)
9   Gastroenterology and Hepatology, KU Leuven University Hospitals Leuven, Leuven, Belgium (Ringgold ID: RIN60182)
,
Jahnvi Dhar
10   Gastroenterology, PGIMER, Chandigarh, India (Ringgold ID: RIN29751)
,
11   Interdisciplinary Endoscopy, Medical Department I, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
,
Rodica Gincul
12   Gastroenterology, Jean Mermoz Private Hospital, Lyon, France (Ringgold ID: RIN89686)
,
Istvan Hritz
13   Centre for Therapeutic Endoscopy, Semmelweis University, Budapest, Hungary (Ringgold ID: RIN37637)
,
Leena Kylänpää
14   Surgery, Helsinki Univeristy Central Hospital, Helsinki, Finland
,
15   Endoscopy Unit, Hospital General Universitario de Alicante, Alicante, Spain (Ringgold ID: RIN16802)
,
Martina Pezzullo
16   Radiology, Erasmus Hospital, Bruxelles, Belgium (Ringgold ID: RIN70496)
,
17   Gastroenterology, Colentina Clinical Hospital, Bucharest, Romania
18   Internal Medicine Department, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
,
10   Gastroenterology, PGIMER, Chandigarh, India (Ringgold ID: RIN29751)
,
19   Gastroenterology and Hepatology, Amsterdam UMC Locatie VUmc, Amsterdam, Netherlands (Ringgold ID: RIN1209)
,
George Webster
20   Pancreatobiliary Medicine Unit, University College London, London, United Kingdom of Great Britain and Northern Ireland (Ringgold ID: RIN4919)
,
21   Hepatogastroenterology Unit, 2nd Department of Internal Medicine, Propaedeutic, Medical School, National and Kapodistrian University of Athens, "Attikon" University General Hospital, Athens, Greece
› Author Affiliations

Main recommendations

1 ESGE recommends the combination of endoscopic ultrasound-guided tissue acquisition (EUS-TA) and endoscopic retrograde cholangiopancreatography (ERCP)-based tissue acquisition as the preferred diagnostic approach for tissue acquisition in patients with jaundice and distal extrahepatic biliary stricture in the absence of a pancreatic mass.

2 ESGE suggests that brushing cytology should be completed along with fluoroscopy-guided biopsies, wherever technically feasible, in patients with perihilar biliary strictures.

3 ESGE suggests EUS-TA for perihilar strictures when ERCP-based modalities yield insufficient results, provided that curative resection is not feasible and/or when cross-sectional imaging has shown accessible extraluminal disease.

4 ESGE suggests using standard ERCP diagnostic modalities at index ERCP. In the case of indeterminate biliary strictures, ESGE suggests cholangioscopy-guided biopsies, in addition to standard ERCP diagnostic modalities. Additional intraductal biliary imaging modalities can be selectively used, based on clinical context, local expertise, and resource availability.

Supplementary Material



Publication History

Article published online:
17 December 2024

© 2024. European Society of Gastrointestinal Endoscopy. All rights reserved..

Georg Thieme Verlag KG
Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany

 
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