What is bile duct stricture and how should it be treated?
What is a bile duct stricture?
The bile duct is formed from the micro bile ducts formed by the liver cells in the liver, to the intrahepatic bile duct, and then to the relatively thick common bile duct, all the way to the intestinal tract. The distribution of all bile ducts is like a tree. The narrowing or obstruction of the bile duct in any part is called bile duct stenosis, and the common clinical stenosis is mainly the stenosis of the common bile duct and the stenosis of the main branches of the intrahepatic bile duct.
Bile duct strictures can be caused by a variety of etiologies, and are classified into two categories: benign bile duct strictures and malignant bile duct strictures according to their pathological types. At present, the differential diagnosis of bile duct strictures is still difficult, and early diagnosis can help patients with malignant strictures obtain the best prognosis and avoid unnecessary surgery for patients with benign strictures.
Causes of bile duct strictures
· Causes of benign bile duct strictures
Benign Biliary Stricture (BBS) refers to the local formation of scar tissue in the bile duct lumen caused by a series of non-malignant diseases, eventually resulting in complete or incomplete stenosis of the bile duct. Untreated benign bile duct strictures are often secondary to complications that can lead to serious adverse outcomes (irreversible liver cell damage, recurrent sepsis, etc.).
- Inflammatory diseases
Inflammatory stricture caused by bile duct stones complicated by infection, chronic pancreatitis, cholangitis (primary sclerosing cholangitis, IgG4-related sclerosing cholangitis).
- History of biliary surgery
Cholecystectomy, pancreaticoduodenectomy, biliary-enteric (liver-enteric) anastomosis, after liver transplantation.
3, iatrogenic injury
Improper operation of biliary tract, inflammatory contraction and stenosis after damage to the bile duct.
- Other situations
Blood vessels compress the bile duct and bile duct stones cause bile duct obstruction and relative stenosis.
· Causes of malignant bile duct strictures
Malignant Biliary Stricture (MBS) refers to tumor stenosis caused by primary or exogenous compression of bile ducts such as bile duct cancer, pancreatic cancer, ampullary cancer, and metastatic cancer.
Treatment of bile duct strictures
· An examination
The most routine examination for bile duct stenosis is abdominal ultrasound, which can only be used as a primary screening tool for benign bile duct stenosis. When malignant bile duct stenosis is highly suspected, contrast-enhanced CT and MRCP should be performed. The combination of the two methods can improve the accuracy of diagnosis.
There are different treatment methods for benign and malignant bile duct stenosis, mainly surgical treatment, the principle is “relieve the stenosis, unobstructed drainage”. In clinical practice, only about 15% to 24% of bile duct strictures are benign, and most of them are caused by malignant lesions. Many malignant patients have no obvious symptoms in the early stage, so the diagnosis is difficult, and the best treatment opportunity is lost. Therefore, all patients with bile duct stenosis should be paid high attention, and timely medical treatment and detailed evaluation should be carried out.