Endoscopic management of benign bile duct strictures

Endoscopic treatment for benign biliary strictures has largely replaced surgical and percutaneous approaches because of lower morbidity and mortality. However, endoscopic therapy often requires multiple procedures and serial stenting for 1 year or longer. Although the optimal algorithm for endoscopic therapy is unknown, most experts agree that maximal dilation and stenting for a period of at least 3 months will result in the best short- and long-term outcomes. Dominant strictures related to sclerosing cholangitis are more challenging to manage and typically respond best to dilation alone or with shorter-term stent therapy. When considering endoscopic treatment, the location and etiology of the stricture have important prognostic implications that may prompt earlier referral to a different subspecialist or alter the endoscopic strategy. Newer stent technologies, such as fully covered self-expandable metallic stents, may alter the treatment paradigm, although future studies are needed before this strategy can be endorsed. This article reviews the current evidence supporting endoscopic therapy for benign biliary strictures, reviews the clinical predictors of long-term success, underscores the technical aspects of dilation and stent placement, and considers future directions for endoscopic treatment.