Biliary stricture

Definition

A biliary stricture is an abnormal narrowing of the common bile duct, the tube that moves bile (a substance that helps with digestion) from the liver to the small intestine.

Causes, incidence, and risk factors

A biliary stricture is often caused by surgical injury to the bile ducts. For example, it may occur after surgery to remove the gallbladder.

Other causes of this condition include:

• Cancer of the bile duct
• Damage and scarring due to a gallstone in the bile duct
• Pancreatitis
• Primary sclerosing cholangitis

Risk factors include previous biliary surgery, pancreatitis, gallstones, or injury to the intestine.

Symptoms

• Abdominal pain
• Chills
• Fever
• Itching
• Jaundice
• Nausea and vomiting
• Pale or clay-colored stools

Signs and tests

The following tests can help diagnose this condition:

• Endoscopic retrograde cholangiopancreatography (ERCP)
• Percutaneous transhepatic cholangiogram (PTC)
• Magnetic resonance cholangiopancreatography (MRCP)

The following blood tests can help reveal abnormal function of biliary system.

• Alkaline phosphatase (ALP) is higher than normal.
• Bilirubin level is higher than normal.

This condition may also alter the results of the following tests:

• Amylase level
• Lipase level
• Fecal fat
• Urine bilirubin
• Prothrombin time (PT)

Treatment

The goal of treatment is to correct the narrowing and help bile flow normally from the liver into the intestine. This may involve surgery or less invasive procedures (endoscopic or percutaneous dilation). Depending on the location, if surgery is done, the stricture may be removed and the common bile duct rejoined with the small intestine.

In some cases, a stent is placed across the bile duct stricture to keep it open.

Expectations (prognosis)

Treatment is usually successful.

Complications

Recurrent inflammation of the biliary duct and stricture can occur in some patients. Patients are at risk for infection developing above the stricture. Long-standing strictures can lead to cirrhosis.

Calling your health care provider

Call for an appointment with your health care provider if symptoms recur after pancreatitis, cholecystectomy, or other biliary surgery.

References

Ostroff JW, LaBerge JM. Endoscopic and radiologic treatment of biliary disease. In: Feldman M, Friedman LS, Sleisenger MH, eds. Sleisenger & Fordtran’s Gastrointestinal and Liver Disease. 8th ed. Philadelphia, Pa: Saunders Elsevier; 2006:chap 67.