Biliary Stricture – Causes, Symptoms and Treatment
The common bile duct is a structure through which bile flows from the liver via the gall bladder into the small intestine. Bile is a greenish yellow liquid which helps in the metabolism of food especially sugar and carbohydrates.
refers to a condition characterized by an abnormal narrowing of the common bile duct. The abnormal narrowing causes an obstruction for the bile to flow into the duodenum which is the first part of the small intestine. The pent up bile acids accumulating in the bile duct starts a necrotizing action whereby the cells of the bile duct and the liver undergo degeneration, disease and destruction. It also causes the bilirubin in blood to shoot up causing jaundice or yellowing of skin and eyes.
What are the causes of biliary stricture?
- The most common cause of the said condition is a trauma or injury caused to the common bile duct during surgery or cholecystectomy for gallbladder removal. About 0.1 to 1.0 % of all cholecystectomy procedures lead to such injuries and later on develop into the discussed condition.
- Cholangiocarcinoma or cancer of the bile ducts.
- Gallstones trapped in the bile duct can also damage and scar them.
- Pancreatitis or an acute inflammation of the pancreas.
- Primary sclerosing cholangitis or the inflammation, infection, destruction and scarring of the intra- hepatic (portion of bile duct inside the liver) and extra-hepatic (portion of the bile duct outside the liver) bile duct.
- Previous history of bile duct injury, pancreatitis, gallstones or intestinal injury increases the risk of the disease.
Symptoms of the disease
- Abdominal pain in the upper right quadrant.
- Fever with chills.
- Pruritus or an intense urge to itch.
- Jaundice or yellowing of skin and eyes.
- Yellow urine and pale clay colored stools.
Diagnostic Tests done to detect the Condition
- Blood Tests can detect elevated liver enzyme alkaline phosphatse (ALP) and bilirubin indicating the said condition. Elevation in the pancreatic enzymes amylase and lipase also happen when pancreatitis leads to the condition.
- Endoscopic Retrograde Cholangiopancreatography (ERCP)
- Percutaneous transhepatic cholangiogram (PTC)
- Magnetic Resonance Cholangiopancreatography (MRCP)
Treatment involves strategy to reverse the narrowing of the bile duct. Surgery or minimally invasive procedures like endoscopy or percutaneous dilation may be used to widen the stricture or remove it and reestablish the connection between the bile duct and the intestine. Stents ( metal or plastic) may be used to widen the bile duct and enable the bile to flow.
Prognosis of Biliary Stricture
Patients having the condition due to surgery, trauma, injury, radiation and pancreatitis have a good prognosis as they respond well to treatment. Patients with the condition due to primary sclerosing cholangitis or cancer have a less favorable future.