Primary Sclerosing Cholangitis with High-Grade Common Bile Duct Stricture and Obstructive Cholestasis
In primary sclerosing cholangitis, a high-grade biliary stricture — defined as greater than 75% reduction of duct diameter on MRI or MRCP — in the common bile duct or hepatic ducts, accompanied by signs or symptoms of obstructive cholestasis and/or bacterial cholangitis, constitutes a relevant stricture and an indication for therapeutic intervention.
Clinical scenario
Therapeutic endoscopic intervention is recommended when a PSC patient presents with a relevant stricture: a high-grade stricture confirmed on MRI/MRCP in the common bile duct or hepatic ducts, with clinical or biochemical evidence of obstructive cholestasis and/or bacterial cholangitis.
Treatment Goals
Improvement of serum liver tests and relief of symptoms associated with biliary obstruction.
Therapeutic Approach
An endoscopic intervention applied directly to the obstructed biliary segment is the recommended approach to restore bile flow from the affected parts of the liver.
Specific technique, procedural sequencing, and post-intervention management are detailed in the full structured protocol.
References
DOI: 10.1016/j.jhep.2022.05.011
- Therapeutic endoscopic intervention is recommended in patients with relevant strictures, defined as high-grade strictures on imaging in the common bile duct or hepatic ducts and signs or symptoms of obstructive cholestasis and/or bacterial cholangitis.
- A biliary stricture on MRI/MRCP with >75% reduction of duct diameter in the common bile duct or hepatic ducts.
- Endoscopic stricture dilatation using bougies or balloon catheters is applied to improve bile flow from obstructed parts of the liver.
- Stricture dilatation improves serum liver tests and symptoms associated with obstruction and is fundamental in the setting of bacterial cholangitis.
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