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Biliary Strictures - Causes, Symptoms, Diagnosis, Treatment, and Complications

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Biliary stricture is a shrinkage in the size of the common bile duct. This article showcases the details of the causes and management of biliary stricture.

Written by

Dr. Janani R S

Medically reviewed by

Dr. Mohammad Rajja

Published At September 13, 2022
Reviewed AtAugust 17, 2023

Introduction:

Biliary stricture is the minimized size of the bile duct than its standard size. A bile duct is a tube-like resembling structure that transports bile from the liver and gallbladder to the intestine. The narrowing is caused by damage to the bile duct or any infection in the bile duct. They exhibit symptoms like pain in the upper stomach region, nausea, and pale-colored stools. This condition is ruled out by performing imaging studies like ultrasound and endoscopic retrograde cholangiopancreatography (ERCP). Biliary stricture is usually treated by placing a stent and draining the accumulated bile.

What Is Biliary Stricture?

Biliary means associated with bile or bile duct. Stricture is narrowing or compression. Biliary stricture is also called bile duct stricture. The bile duct helps transfer bile from the liver to the duodenum, the first part of the small intestine. Bile is a greenish liquid that removes wastes from the blood and helps process the fats into fatty acids, which the body will absorb. When there is a narrowing in this tubular duct, bile build-up leads to a series of symptoms.

What Causes Biliary Stricture?

Biliary strictures can occur during birth (congenital) or acquired from the below-mentioned benign (non-cancerous) and malignant (cancerous) conditions. The congenital form is rare.

  • Bile Duct Cancer: A tissue growth in the bile duct. It is a rare type of cancer but very destructive.

  • Impairment Due to Gallstones in the Bile Duct: The presence of gallstones stuck in the bile duct causes bile duct narrowing. This condition is very painful and causes damage to other associated organs like the pancreas, liver, and digestive system.

  • Scarring of the Bile Duct as a Result of Gallbladder Removal: The bile duct is sometimes damaged during surgical removal of the gallbladder. This leads to inflammation (swelling) and scar formation. The bile duct becomes less narrow due to scarring.

  • Pancreatitis: Pancreas is present in the upper abdominal region at the back of the stomach. It plays a vital role in digestion and maintains the hormones that process glucose (blood sugar). Pancreatitis means when the pancreas is inflamed or swollen.

  • Primary Sclerosing Cholangitis: Primary sclerosing cholangitis is a liver disease that develops over time. The bile ducts present inside and outside the liver are swollen, become reddish, and eventually result in scar formation. This, in turn, causes compression or blockage of the bile duct.

  • Abdominal Trauma: Blunt trauma or injury to the stomach during an accident or petty fights causes damage to the bile duct. This injury leads to inflammation and scar formation and finally leads to the narrowing of the bile duct.

  • Infections of Bile Duct: Bacterial infection of the bile occurs suddenly, or the infection develops over time. This infection causes the bile duct to swell, which leads to scar formation and causes narrowing in the end.

  • Mirizzi Syndrome: This syndrome involves obstruction or blockage of the common bile duct. The blockage may be due to pressure caused by a stone stuck in the gallbladder’s infundibulum part (the narrow part of the gallbladder connecting the neck part and the body) or a cystic duct (a tubular structure that joins the top part of the gallbladder neck and the common bile duct).

  • Oriental Cholangiohepatitis: This condition develops over time, and the severity is aggravated by a parasitic (microorganism that survives on other organisms) infection. This causes a narrowing of the biliary tree and numerous stones formation in the tiny network of tubes inside and outside the liver. These tubes transport bile inside the liver.

  • Post Radiation Therapy: The bile duct wall is thickened as a complication of radiation therapy in patients with cancer. This occurs over time and progressively causes narrowing of the bile duct and obstruction.

What Are the Symptoms of Biliary Stricture?

  • Nausea.

  • Vomiting.

  • Pain in the right upper region above the stomach.

  • Jaundice (yellowish discoloration of the skin and the eyes).

  • Pale-colored stool.

  • Fever.

  • Chills.

  • Loss of appetite.

  • Feeling uneasy.

What Are the Tests to Find Biliary Strictures?

  • Liver Function Tests: Liver function tests are a group of tests that screen the enzymes and proteins present in the liver. Enzymes like aspartate transaminase (AST), alanine transaminase (ALT), alkaline phosphatase (ALP), and gamma-glutamyl transferase (GGT) are checked. Proteins like albumin, globulin and fibrinogen are also checked for changes in the levels. Bilirubin levels are also reviewed to figure out any abnormality.

  • Complete Blood Count: In the complete blood count, blood samples are collected and screened for certain components like platelets, red blood cells, hemoglobin, and white blood cells. Changes in the normal levels of these parameters reveal the infection.

  • Prothrombin Time: It is the time taken for the blood to clot (become thick). Prothrombin is a protein produced in the liver that plays a role in blood clot formation. Therefore, prolonged prothrombin time denotes liver disease.

  • Ultrasound Abdomen: The ultrasound technique uses sound waves to capture images of the internal structures to figure out the abnormality.

  • CT Scan: Computed tomography uses X-ray radiation targeted at an organ at different angles, and the images are captured with the help of a computer. This technique gives a detailed image of the structure.

  • MRI Scan: Magnetic resonance imaging (MRI) uses a combination of high-frequency sound waves in a magnetic field to capture images of internal organs and structures. This gives a detailed view of the soft tissues and internal organs.

  • Endoscopic Retrograde Cholangiopancreatography (ERCP): Endoscopic retrograde cholangiopancreatography uses a combination of radiation and endoscopic technique. An endoscope is a flimsy flexible tube with a light and camera at one end. It is inserted into the mouth, the internal organs are viewed, and images are captured with X-rays.

  • Percutaneous Transhepatic Cholangiography (PTC): This technique is performed by puncturing the liver through the abdominal wall with a needle. A catheter is inserted, and a contrast medium (like iodine) is injected. This medium causes a few changes in the narrowed part of the bile duct. This is captured using an X-ray. This technique is very useful in finding biliary strictures when other diagnostic tests are not helpful.

How Is Biliary Stricture Treated?

  • Endoscopic Retrograde Cholangiography (ERCP): This technique uses an endoscope along with X-rays. An endoscope is a thin, compressible tube attached to a light and a camera. This tube is introduced into the mouth, passes the food pipe, and reaches the stomach and the small intestine. The bile duct is present in such a way that it forms a connection with the small intestine, where the endoscope accesses the bile duct. Next, a catheter (a tube used in surgical procedures or used to infuse liquids) is inserted into the bile duct, and the compression in the bile duct is released by placing a stent (a mini tube placed in hollow organs).

  • Percutaneous Transhepatic Cholangiography (PTC): The percutaneous transhepatic cholangiography technique uses a catheter to treat bile duct stricture. The abdominal wall is punctured with a needle, and the liver and the bile duct are accessed. Next, a catheter is inserted into the accessed bile duct, and the narrowing in the bile duct is released by opening the compressed part.

  • Surgery: Surgical removal of the compressed part of the bile duct is performed in some cases. This procedure is rarely performed.

What Are the Complications of Biliary Strictures?

  • Calcification or stone formation in the gallbladder.

  • Bile stone formation on the sides of the compressed bile ducts.

  • A pyogenic liver abscess (pus-filled sac or pus-producing sac in the liver).

  • Secondary biliary cirrhosis (swelling and demolition of the bile ducts due to an autoimmune response or pre-existing lesion or long-term blockage of the bile duct). The autoimmune response happens when the body’s immune system attacks its healthy organs or tissues.

  • Weight loss.

What Is the Prognosis of Biliary Stricture?

The biliary stricture usually has a good prognosis. However, patients with HIV cholangiopathy or cancerous biliary obstruction often have the disease spread to other parts and visit the doctor at advanced stages. The prognosis is poor in these patients.

Conclusion:

Biliary strictures are narrowing of the bile ducts, which causes reduced bile flow. This causes a series of painful symptoms. There are techniques like endoscopic retrograde cholangiopancreatography (ERCP), percutaneous transhepatic cholangiography (PTC), and imaging techniques to discover the disease once the symptoms develop. These techniques confirm the condition, and treatment is planned accordingly. However, treating this condition in patients with advanced stages of bile duct cancer can be challenging. Thus, following the treatment properly relieves the patient from the symptoms, resolving the condition.

Dr. Mohammad Rajja
Dr. Mohammad Rajja

General Practitioner

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