Primary Sclerosing Cholangitis with High-Grade Common Bile Duct Stricture
In primary sclerosing cholangitis, a subset of patients develop a relevant biliary stricture — a high-grade narrowing of the common bile duct or hepatic ducts on imaging — associated with obstructive cholestasis or bacterial cholangitis. This scenario defines a distinct clinical situation that requires a specific management approach.
Clinical Scenario
A relevant stricture is defined as a 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. Therapeutic intervention is indicated when these criteria are met.
Management Approach
When the stricture cannot be managed by endoscopic means alone, a percutaneous interventional approach to biliary drainage may be applied — the complete protocol covers the applicable techniques and clinical decision points.
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.
- If a hilar stricture cannot be overcome via endoscopic intervention, a percutaneous rendez-vous approach or temporary external-internal drainage can be applied.
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