This protocol targets a specific escalation point in primary sclerosing cholangitis: a patient with a relevant high-grade biliary stricture whose initial endoscopic dilatation did not achieve the expected improvement in serum liver tests or symptoms of biliary obstruction.
Imaging — MRI or MRCP — demonstrates a high-grade biliary stricture with more than 75% reduction of duct diameter in the common bile duct or hepatic ducts. The patient has signs or symptoms of obstructive cholestasis and/or bacterial cholangitis, meeting the threshold for therapeutic endoscopic intervention.
The first-line intervention — endoscopic stricture dilatation using bougies or balloon catheters to improve bile flow from the obstructed duct — has already been performed. The intended goals of improvement in serum liver tests and relief of obstructive symptoms were not reached. This protocol defines the next management step.
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.
In patients with complex strictures or a lack of apparent dilation effect during ERCP, a stent may be placed after successful stricture dilation.
Therefore, the stent should be removed within 2‑4 weeks of placement.
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