Biliary strictures:diagnostic considerations and approach

作     者：Ajaypal Singh Andres Gelrud Banke Agarwal 

作者机构：Center for Endoscopic Research and TherapeuticsDivision of GastroenterologyUniversity of Chicago Medical CenterChicagoILUSA Division of Gastroenterology and HepatologySaint Louis University School of Medicine.St.LouisMOUSA 

出 版 物：《Gastroenterology Report》 (胃肠病学报道（英文）)

年 卷 期：2015年第3卷第1期

页      面：22-31页

核心收录：

学科分类：1002[医学-临床医学] 100201[医学-内科学(含：心血管病、血液病、呼吸系病、消化系病、内分泌与代谢病、肾病、风湿病、传染病)] 10[医学] 

基　　金：NCATS NIH HHS [UL1 TR000430] Funding Source: Medline NATIONAL CENTER FOR ADVANCING TRANSLATIONAL SCIENCES [UL1TR000430] Funding Source: NIH RePORTER 

主　　题：biliary stricture endoscopic ultrasound endoscopic retrograde cholangiopancreatography magnetic resonance cholangio-pancreatography intraductal ultrasound cholangioscopy 

摘      要：Biliary strictures present a diagnostic challenge,especially when no etiology can be ascertained after laboratory evaluation,abdominal imaging and endoscopic retrograde cholangiopancreatography(ERCP)*** strictures were traditionally classified as indeterminate strictures,although with advances in endoscopic techniques and better understanding of hepato-biliary pathology,more are being correctly *** implications of missing a malignancy in patients with biliary strictures—and hence delaying surgery—are grave but a significant number of patients(up to 20%)undergoing surgery for suspected biliary malignancy can have benign *** diagnostic approach to these patients involves detailed history and physical examination and depends on the presence or absence of jaundice,level of obstruction,and presence or absence of a mass *** abdominal imaging helps to find the level of obstruction and provides a‘road map’for further endoscopic investigations,tissue diagnosis is usually needed to make decisions on *** ERCP was the only modality to investigate these strictures but now,with the development of endoscopic ultrasound with fine needle aspiration and the availability of newer techniques such as intraductal ultrasound,single-operator cholangioscopy and confocal laser endomicroscopy,the diagnostic approach to biliary strictures has changed *** this review,we will focus on the decision-making process for patients with biliary strictures and discuss the key decision points that should dictate further diagnostic investigations at each step.