Biliary Stricture

What is a biliary stricture?

A biliary stricture occurs when your bile ducts narrow due to disease, scarring or blockage. This narrowing restricts the flow of bile from your liver to your small intestine. When bile builds up, your body has a harder time digesting food. Another term for biliary stricture is bile duct stricture.

What are bile ducts?

Your bile ducts are tubes that connect organs in your digestive system. Your liver makes bile, a fluid that aids digestion. Your bile ducts carry this liquid to your small intestine where acid in the bile breaks down fats and proteins in food. Your bile duct joins the pancreatic duct that carries enzymes (proteins) your body uses for digestion.

How common is biliary stricture?

Experts aren’t sure how many people develop biliary strictures every year. But the condition seems to be on the rise. This may be due to an increase in gallbladder removal surgery, particularly laparoscopic cholecystectomy. These procedures may damage or scar the bile ducts, causing them to narrow. Biliary strictures rarely affect children.

What causes a biliary stricture?

Rarely, a baby is born with narrowed bile ducts. This is a type of birth defect (congenital condition). More commonly, cancer causes about 7 in 10 biliary strictures. Pancreatic cancer and bile duct cancer (cholangiocarcinoma) are the primary causes of biliary strictures.

These cancers can also cause narrowing of the bile ducts:

• Gallbladder cancer.
• Hepatocellular carcinoma.
• Liver cancer.
• Lymphoma.
• Metastasis (metastatic cancer).
• Small intestine cancer.

What other conditions cause a biliary stricture?

These noncancerous (benign) conditions, as well as certain procedures, cause about 30% of biliary strictures:

• Abdominal injuries or trauma.
• Autoimmune pancreatitis and pancreatitis.
• Bile duct scarring from gallstones.
• Mirizzi syndrome (impacted gallstones).
• Primary biliary cholangitis.
• Primary sclerosis cholangitis.
• Radiation therapy.

What is an anastomotic biliary stricture?

An anastomotic biliary stricture may occur after a Whipple procedure or liver transplantation. During these procedures, a surgeon reconnects passages in the gastrointestinal tract. This reconnection, or anastomosis, can injure or scar the bile ducts. As a result, you develop an anastomotic biliary stricture.

What are the symptoms of a biliary stricture?

Signs of a biliary stricture include:

• Abdominal pain in your upper right side.
• Fever and chills.
• Changes in stool (poop) color (gray or pale-colored stools).
• Itchy skin (pruritus).
• Jaundice.
• Loss of appetite.
• Nausea and vomiting.

What are the complications of a biliary stricture?

If a bile duct remains narrowed or blocked for too long, bile can build up in your liver. You may develop an infection, liver disease and liver scarring (cirrhosis of the liver).

What healthcare providers diagnose and treat biliary strictures?

For diagnosis and treatment, you’ll see a gastroenterologist. These doctors diagnose and treat gastrointestinal (GI) disorders like biliary strictures.

How do healthcare providers diagnose biliary strictures?

Your gastroenterologist may order blood tests, including:

• Bilirubin test to measure levels of bilirubin. This waste product in bile builds up when bile ducts become narrow or blocked.
• Liver function tests to check for elevated liver enzymes.

What imaging tests detect biliary strictures?

You may get one or more of these imaging tests to check for biliary strictures:

• Ultrasound: An ultrasound produces images that show changes in biliary structures that indicate a blockage or narrowing. You may get an endoscopic ultrasound, abdominal ultrasound or liver ultrasound.
• Endoscopic retrograde cholangiopancreatography (ERCP): An ERCP combines an upper endoscopy procedure and X-rays. Your provider threads an endoscope (lighted, flexible tube) through your numbed esophagus to reach your abdominal organs and bile ducts. Your provider may use special instruments to remove tissue samples for a biopsy. A biopsy can detect cancer cells.
• Magnetic resonance cholangiopancreatography (MRCP): This advanced MRI produces detailed images of your bile ducts, liver, pancreas and gallbladder.
• Percutaneous transhepatic cholangiography (PTC): This special type of X-ray allows your provider to view an injectable contrast dye as it moves from your liver to your bile ducts and small intestine. The dye highlights blockages.

How are biliary strictures treated?

Your healthcare provider can treat certain causes of biliary strictures during diagnosis with ERCP or PTC.

Depending on the cause, your provider may:

• Break up and remove gallstones.
• Use a balloon device to expand the narrowed bile duct and place a stent (metal or plastic tube) to keep it open.
• Remove tumors.

What are surgical treatments for biliary strictures?

A small number of people need surgery to treat a biliary stricture. Surgery may be an option if cancer causes the narrowing. Surgery options include:

• Bypass that goes around the narrowed bile duct to allow bile to flow directly into your small intestine.
• Resection (removing the diseased bile duct) and anastomosis.

Can a biliary stricture happen again?

Yes, it’s possible for a bile duct to narrow again after treatment to open it. If this happens, your provider may perform bile duct exploration surgery to remove the narrowed bile duct. After removal, they reconnect your healthy bile ducts and small intestine.

What complications can occur after treatment?

Post-treatment complications vary depending on the treatment. Some people develop acute (sudden onset) pancreatitis (inflammation of your pancreas) after ERCP treatment.

Can you prevent biliary strictures?

You can take steps to lower your risk of certain conditions that cause biliary strictures. For instance:

• Eat a healthy diet with fresh fruits and vegetables.
• Lower your cholesterol numbers to protect the health of your gallbladder and prevent gallstones.
• Maintain a weight that’s healthy for you.
• Seek help for alcohol use disorder to prevent pancreatitis and liver damage.

What’s the outlook for someone with a biliary stricture?

Your outlook depends on the cause of the biliary stricture. Treatments to open narrowed bile ducts are typically successful. However, the condition that caused the narrowing may require more complex treatments.

What is recovery like after treatment for biliary strictures?

Your recovery, including how quickly you can return to work, school and normal activities, depends on the type of treatment you have. Minimally invasive treatments like ERCP promote a faster recovery with less pain compared to open surgeries that take place through larger incisions.

You should follow your healthcare provider’s recommendations to ensure a safe recovery. This may include temporarily eating soft foods or changing your diet to include easier-to-digest foods.

When should I call the doctor?

You should call your healthcare provider if you experience:

• Chronic fever.
• Recurrent (returning) upper abdominal pain.
• Signs of post-treatment infection, such as drainage or redness.
• Unexplained weight loss, nausea or vomiting.
• Yellowing of the whites of your eyes or skin (jaundice).

What should I ask my provider?

You may want to ask your healthcare provider:

• What caused the biliary stricture?
• What’s the best treatment for me?
• Can I take steps to lower my risk of another biliary stricture?