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Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Endosc. Feb 25, 2016; 8(4): 220-231
Published online Feb 25, 2016. doi: 10.4253/wjge.v8.i4.220
Role of endoscopic retrograde cholangiopancreatography in the management of benign biliary strictures: What’s new?
Rosa Ferreira, Rui Loureiro, Nuno Nunes, António Alberto Santos, Rui Maio, Marília Cravo, Maria Antónia Duarte
Rosa Ferreira, Rui Loureiro, António Alberto Santos, Marília Cravo, Gastroenterology Department, Hospital Beatriz Ângelo, 2674-514 Loures, Portugal
Nuno Nunes, Maria Antónia Duarte, Gastroenterology Department, Hospital Divino Espírito Santo, 9500-370 São Miguel-Açores, Portugal
Rui Maio, Surgery Department, Hospital Beatriz Ângelo, 2674-514 Loures, Portugal
Author contributions: Ferreira R designed research; Ferreira R, Loureiro R, Nunes N, Santos AA wrote the paper; Ferreira R, Loureiro R, Nunes N, Santos AA, Maio R, Cravo M and Duarte MA performed the collected data.
Conflict-of-interest statement: The authors declare no conflicts of interest regarding this manuscript.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Rosa Ferreira, MD, Gastroenterology Department, Hospital Beatriz Ângelo, Avenida Carlos Teixeira, 3, 2674-514 Loures, Portugal. rosa.l.ferreira@gmail.com
Telephone: +351-966-510601 Fax: +351-219-847090
Received: June 2, 2015
Peer-review started: June 3, 2015
First decision: August 7, 2015
Revised: September 25, 2015
Accepted: December 13, 2015
Article in press: December 15, 2015
Published online: February 25, 2016
Processing time: 264 Days and 17.9 Hours
Abstract

Benign biliary strictures comprise a heterogeneous group of diseases. The most common strictures amenable to endoscopic treatment are post-cholecystectomy, post-liver transplantation, related to primary sclerosing cholangitis and to chronic pancreatitis. Endoscopic treatment of benign biliary strictures is widely used as first line therapy, since it is effective, safe, noninvasive and repeatable. Endoscopic techniques currently used are dilation, multiple plastic stents insertion and fully covered self-expandable metal stents. The main indication for dilation alone is primary sclerosing cholangitis related strictures. In the vast majority of the remaining cases, temporary placement of multiple plastic stents with/without dilation is considered the treatment of choice. Although this approach is effective, it requires multiple endoscopic sessions due to the short duration of stent patency. Fully covered self-expandable metal stents appear as a good alternative to plastic stents, since they have an increased radial diameter, longer stent patency, easier insertion technique and similar efficacy. Recent advances in endoscopic technique and various devices have allowed successful treatment in most cases. The development of novel endoscopic techniques and devices is still ongoing.

Keywords: Benign biliary strictures; Bile duct stricture; Endoscopic retrograde cholangiopancreatography; Stents; Cholecystectomy; Liver transplantation; Primary sclerosing cholangitis; Chronic pancreatitis

Core tip: Endoscopic treatment of benign biliary strictures has been evolved in the last decades and is widely considered as first line therapy. Among endoscopic techniques, multiple plastic stents placement is an effective method but requires multiple endoscopic sessions. Fully covered self-expandable metal stents appear as a reasonable alternative due to their larger lumen and longer patency. Emergent data proved their efficacy, their low complications rate and cost-effectiveness. We herein discuss the endoscopic management of benign biliary strictures and focus on the outcomes, advantages and disadvantages of each endoscopic technique.