Surgical Diseases of the Pancreas and Biliary Tree by Savio George Barreto & John A. Windsor

Author:Savio George Barreto & John A. Windsor
Language: eng
Format: epub
ISBN: 9789811087554
Publisher: Springer Singapore

10.22 Biliary Stricture

A benign biliary stricture is seen in 3–46% of patients with CP and is mostly secondary to pancreatic fibrosis, with a small proportion resulting from pancreatic oedema and compression by a pseudocyst [122]. It is important to rule out malignancy in the former by brush cytology or direct biopsy. Even though the initial clinical success rate of biliary stent placement is impressive, stricture resolution is maintained in a mean of only 32% patients by the end of 1 year, mandating surgery in the remaining for long-term benefit [122]. Use of multiple plastic stents has been associated with stricture resolution in 44–90% of cases at a follow-up of 48 months. Self-expanding metallic stents (SEMS) can be an alternative option for patients with refractory strictures who are not ideal candidates for biliary drainage surgery. Occlusion rates of biliary SEMS have been reported to be 10–62% in patients with CP [123].

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