A bile duct stricture may be benign or malignant. Impaired bile flow can cause jaundice, itching, dark urine, infection or abnormal liver tests.
Why is it important? Determining the cause is essential, yet several imaging and sampling methods may be needed to distinguish inflammatory scarring from malignancy.
Diagnosis and treatment Evaluation may include MRCP, EUS, ERCP, brush cytology, targeted biopsy or cholangioscopy. Treatment can involve drainage, dilation or stent placement together with therapy for the underlying cause.
The examination is performed using a flexible instrument (endoscope) that is inserted through the mouth into the duodenum, reaching the opening of the bile and pancreatic ducts.
Through the endoscope's channel, a plastic catheter is introduced into the opening of the papilla, allowing for the injection of iodine-based contrast agent, which (under X-ray guidance) enables visualization of the bile and pancreatic ducts.
With ERCP, it is also possible to perform therapeutic procedures such as removal of stones from the bile and pancreatic ducts, dilation of strictures (obstructions), obtaining tissue samples (in cases of suspected cancer or precancerous conditions), and placing a stent to facilitate drainage of the bile and pancreas and to keep them open, for example, in situations where there is an obstruction.
The ERCP examination typically takes about 40 minutes.
The procedure is performed under sedation, which is administered intravenously prior to the examination.
After receiving sedation, a "bite block" will be placed in your mouth to keep your mouth open throughout the procedure.
The examination is performed while lying on the left side or on the abdomen. During the procedure, monitoring devices will be attached to your body to check your heart rate, blood pressure, and respiratory activity.
During the examination, the doctor inserts the instrument through the mouth and positions it at the site of the papilla, which is the opening of the bile and pancreatic ducts into the small intestine. Through the papilla, it is possible to access the bile or pancreatic ducts for treatment purposes, such as removing stones, taking a biopsy from a mass, or relieving an obstruction.
In certain cases, the patient will receive preventive antibiotics during the procedure to reduce the risk of infection.
Laparoscopic surgery is a common technique performed through small incisions in the body (5-10 millimeters), which eliminates the need for open surgery and allows for a faster recovery.
Obtaining samples from suspicious tissue in the digestive tract and adjacent organs using an endoscopic technique guided by endoscopic ultrasound (EUS).
This method provides access to multiple organs in the body, allowing for assessment of malignant disease spread in order to plan surgeries and treatment approaches.
A cytology brush is an accessory inserted through the endoscope's working channel. It allows the gastroenterologist to gently "brush" the mucosa of the esophagus, stomach, or bile ducts to collect cells for microscopic examination, typically when strictures or tumors are suspected.