Radiological approach to benign biliary strictures

Benign biliary strictures can be attributable to a large variety of causes, but are commonly iatrogenic after direct or vascular injury during laparoscopic cholecystectomy and other biliary procedures. An increasing number of patients present with strictures of bilioenteric anastomoses after liver transplantation and radical surgery for hepatopancreaticobiliary cancer. Endoscopic access to the biliary tree may be difficult or impossible following pancreaticoduodenectomy, and in this context strictures are best approached percutaneously. In the past, strictures could only be managed with repeated balloon dilatations and/or long-term transhepatic catheter placement. This is not very satisfactory from a patient point of view. A long-term external drain is disfiguring and challenging to manage, and the patient has to undergo repeated, potentially very painful procedures. Newer developments attempting to achieve long-term resolution of benign strictures include fully covered, removable metal stents and the emerging option of biodegradable stents. Early outcomes of these new technologies are promising, but require a careful and considered multidisciplinary approach and heavy clinical involvement of the interventional radiologist.