Differential diagnosis of biliary stricture, a challenge in clinical practice
Keywords:
STENOSIS, DIAGNOSIS, TREATMENT.Abstract
Introduction: biliary stricture is a narrowing of intrahepatic or extrahepatic bile ducts of varied etiology; it is suggested that 76-85 % are malignant and the rest correspond to benign causes.
Objective: to describe the differential diagnosis of biliary stricture.
Methods: databases (Pubmed, Cochrane Library, EBSCO, Clinical Key, Springer, MedScape and SciELO) were reviewed in search of articles published to the present date related to the theme.
Development: the absence of specific clinical characteristics of biliary stricture, together with the limitations of imaging and histological tests to make differential diagnosis, constitute a challenge in routine medical practice. Non-invasive diagnostic methods such as abdominal ultrasound, computed tomography and magnetic resonance cholangiography are used for its differentiation. Endoscopic retrograde pancreatic cholangiography and fine needle aspiration cholangioendoscopy are the most commonly used invasive methods. Other more current techniques are per-oral cholangioscopy and intraductal ultrasound, the former with higher cost and risk of complications. The dosage of tumor and biomolecular markers is an element to be taken into account for diagnosis.
Conclusions: determining the differentiation between benign or malignant stenosis is complex and requires the integration of diagnostic means that are not always accessible in all hospital centers. Endoscopic retrograde pancreatic cholangiography with cytology is an invasive study but widely available, with low complication rates and high diagnostic efficacy in expert hands.
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