Bile duct stricture
Patients can present with a wide range of symptoms. Some present with painless jaundice, while others present with obstructive jaundice and cholangitis (right upper quadrant pain, jaundice, fever, and sepsis).
In some circumstances, bile duct stricture can be found incidentally on imaging.
Lab findings can be normal or can demonstrate degrees of biliary obstruction (elevated alkaline phosphatase, elevated alanine transaminase [ALT] / aspartate transaminase [AST], elevated direct bilirubin). Tumor markers (CA 19-9, CEA) can be positive when the bile duct stricture is due to an underlying malignancy, most commonly either cholangiocarcinoma or pancreatic adenocarcinoma.
Diagnosis is often established by endoscopic retrograde cholangiopancreatography (ERCP) or endoscopic ultrasound (EUS) with fine needle aspiration, both modalities leading to a pathologic diagnosis. ERCP is indicated with evidence of obstructive jaundice; otherwise, EUS with fine needle aspiration is preferred.
Treatment depends on the etiology causing the stricture. For malignancies, surgical resection is often attempted. For benign etiologies, biliary stenting and/or treatment of the underlying cause (ie, steroids for autoimmune pancreatitis) is recommended.
K83.1 – Obstruction of bile duct
43797002 – Stricture of bile duct
Differential Diagnosis & Pitfalls
- Post-surgical stricture – following cholecystectomy or liver transplant
- Infectious – parasitic, tuberculosis, human immunodeficiency virus cholangiopathy
- Chronic pancreatitis (including autoimmune pancreatitis)
- Radiation induced
- Mirizzi syndrome – cystic duct stone causing external compression
- Primary sclerosing cholangitis