Biliary strictures, also called bile duct strictures, occur when the ducts that carry bile from your liver to your small intestine become narrow or blocked. Cancer, noncancerous conditions like pancreatitis, and certain types of surgeries can cause biliary strictures. Healthcare providers often use endoscopic procedures to diagnose and treat biliary strictures.
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.
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.
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.
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:
These noncancerous (benign) conditions, as well as certain procedures, cause about 30% of biliary strictures:
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.
Signs of a biliary stricture include:
For diagnosis and treatment, you’ll see a gastroenterologist. These doctors diagnose and treat gastrointestinal (GI) disorders like biliary strictures.
Your gastroenterologist may order blood tests, including:
You may get one or more of these imaging tests to check for biliary strictures:
Your healthcare provider can treat certain causes of biliary strictures during diagnosis with ERCP or PTHC.
Depending on the cause, your provider may:
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:
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.
Post-treatment complications vary depending on the treatment. Some people develop acute (sudden onset) pancreatitis (inflammation of your pancreas) after ERCP treatment.
You can take steps to lower your risk of certain conditions that cause biliary strictures. For instance:
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.
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.
You should call your healthcare provider if you experience:
You may want to ask your healthcare provider:
A note from Cleveland Clinic
Symptoms like abdominal pain, fever, chills and jaundice can be worrisome, especially if they come on suddenly. If you develop these symptoms, it’s a good idea to tell your healthcare provider right away. They can run tests to find out why and recommend appropriate treatment.
Last reviewed by a Cleveland Clinic medical professional on 10/16/2023.
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