Dr. Aditya Kulkarni is a Consultant Laparoscopic and Robotic Gastrointestinal, Hepato-biliary-pancreatic and Cancer Surgeon at the renowned Ruby Hall Clinic,
BENIGN BILIARY STRICTURE
The bile duct is the tube that takes bile from the liver to the small intestine. Benign Biliary stricture, also referred to as bile duct stricture, occurs when the bile duct gets smaller or narrower. When the duct becomes narrow, it makes it difficult for bile to reach the intestine. Patients with mild biliary strictures may not show any symptoms. When symptoms develop, they may include jaundice (yellowing of the skin), itching, and lightening of stool colour.
Biliary strictures can be caused by:
- Any damage done to the bile duct (after gallbladder removal surgery or the presence of a gallstone in the bile duct)
- Swelling of the bile duct
- Pancreatitis (inflammation of the pancreas)
- Intestinal injuries
- Cancer in the bile duct or pancreas
Symptoms of biliary stricture:
- Pain in the upper right side of the abdomen
- Chills and fever
- Nausea or vomiting
- Gray-colored or pale-colored stool
CT scan: It helps to show the site of the stricture, and the status of the liver.
MRI- MRCP: It is the best investigation for biliary stricture and shows the location and extent of the stricture accurately.
Percutaneous transhepatic cholangigraphy: It is performed when the patient has got a biliary drainage tube in place. Dye is injected into the tube and X ray pictures are taken to see the bile ducts above the stricture.
Treatment of biliary stricture
Biliary strictures need to be treated, otherwise the back pressure of obstructed bile flow leads to liver damage which may be permanent. Options for treatment include
Endoscopic stent placement: ERCP with stenting is an endoscopic procedure. Plastic or metallic stent can be placed. However long-term management with stenting can be problematic.
Surgery involves surgical bypass of the strictured area by connecting a loop of intestine to an area of healthy bile duct. This procedure is called as hepaticojejunostomy (when jejunum is joined to the bile duct) or choledochoduodenostomy (when duodenum is used). This procedure can be performed in open or minimally invasive technique. Laparoscopic or robotic biliary drainage gives faster recovery, reduced pain and shorter hospital stay.