Approach to the patient with a biliary stricture

The evaluation of biliary strictures often presents a diagnostic challenge, as missing a malignancy can have catastrophic effects. A variety of diagnostic modalities are available. After a thorough history and physical are obtained, key laboratory information including liver function tests and CA 19-9 levels should be obtained. Radiological imaging, in the form of transabdominal ultrasound, computerized tomography, and magnetic resonance imaging, are instrumental for the determining etiology. Endoscopic evaluation through ERCP with sampling, endoscopic ultrasound, cholangioscopy, and confocal laser endomicroscopy are crucial in the evaluation, and are used as complementary diagnostic tools.