Abstract

The ACG guidelines for the diagnosis and management of bile duct stricture

Bile duct stricture is defined as a narrowing of the bile duct diameter, which can lead to a clinically overt bile flow disorders. Any narrowing of the bile duct should be considered a cause for concern and an appointment with a cancer specialist because it is most commonly caused by a malignant neoplasm. The diagnostic and therapeutic management of patients with a narrowing of the bile duct should be oriented towards confirming or excluding of a malignant neoplasm (diagnosis) and restoring normal bile flow (drainage). The diagnostic and therapeutic pathways tend to vary according to the anatomical location of the narrowing (extrahepatic or perihilar). The basis for the diagnosis of extrahepatic stenosis is endosonography-guided biopsy, however, the diagnosis of perihilar stenosis continues to present serious challenges. The drainage of extrahepatic biliary tract stenosis seems to be simpler, safer and less controversial as compared to the drainage of perihilar biliary stenosis. The data obtained over the recent years have paved the way for a number of clear-cut recommendations. This highlights, however, the need for additional research. These guidelines are designed to provide clinicians with evidence-based recommendations for the management of patients with extrahepatic and perihilar biliary duct stenosis, with focus on the diagnostic workup and drainage procedures.