Abstract
Differentiating benign and malignant biliary strictures is a challenging and important
clinical scenario. The typical presentation is indolent and involves elevation of
liver enzymes, constitutional symptoms, and obstructive jaundice with or without superimposed
or recurrent cholangitis. While overall the most common causes of biliary strictures
are malignant, including cholangiocarcinoma and pancreatic adenocarcinoma, benign
strictures encompass a wide spectrum of etiologies including iatrogenic, autoimmune,
infectious, inflammatory, and congenital. Imaging plays a crucial role in evaluating
strictures, characterizing their extent, and providing clues to the ultimate source
of biliary obstruction. While ultrasound is a good screening tool for biliary ductal
dilatation, it is limited by a poor negative predictive value. Magnetic resonance
cholangiopancreatography is more than 95% sensitive and specific for detecting biliary
strictures with the benefit of precise anatomic localization. Other commonly employed
imaging modalities include endoscopic retrograde cholangiopancreatography with endoscopic
ultrasound, contrast-enhanced CT, and cholangiography. First-line treatment of benign
biliary strictures is endoscopic dilation and stenting. In patients with anatomy that
precludes endoscopic cannulation, percutaneous biliary drain insertion and balloon
dilation is preferred.
Keywords
biliary strictures - benign stricture - percutaneous transhepatic cholangiogram -
percutaneous biliary drainage - interventional radiology
