Current status of endoscopic treatment for patients with benign biliary strictures

Abstract

Endoscopic treatment for the patients with benign biliary stricture (BBS) has become an alternative to surgery or percutaneous transhepatic biliary drainage. Lots of papers reported the feasibility and the effectiveness of fully covered self-expandable metallic stents (FCSEMS). FCSEMS deployment is superior to multiple plastic stent deployment in the technical feasibility and the frequency of stent exchange. Treatment results such as resolution rate and re-stricture rate of BBS associated with chronic pancreatitis are not so good as postoperative BBS, and therefore, surgical approach is one of the therapeutic options. Patients with postoperative BBS have good prognoses once strictures are resolved. However, BBS after living donor liver transplantation is difficult to achieve technical success and stricture resolution. As a first endoscopic therapy, only balloon dilation without stent deployment should be employed for the patients with primary BBS associated with primary sclerosing cholangitis to avoid refractory cholangitis. The management for the patients which required long-term therapy and repeated procedures remains to be resolved.