Clinical approach to indeterminate biliary strictures:Clinical presentation,diagnosis,and workup  

作　　者：Sujani Yadlapati Ramzi Mulki Sergio A Sánchez-Luna Ali M Ahmed Kondal Rao Kyanam Kabir Baig Shajan Peter 

机构地区：[1]Department of Gastroenterology and Hepatology,Indiana University Hospital,Indianapolis,IN 46202,USA [2]Department of Gastroenterology and Hepatology,University of Alabama at Birmingham,Birmingham,AL 35294,USA

出　　处：《World Journal of Gastroenterology》2023年第36期5198-5210,共13页世界胃肠病学杂志（英文版）

摘　　要：Despite advances in cross-sectional imaging and endoscopic technology,bile duct strictures remain a challenging clinical entity.It is crucial to make an early determination of benign or malignant nature of biliary strictures.Early diagnosis not only helps with further management but also minimizes mortality and morbidity associated with delayed diagnosis.Conventional imaging and endoscopic techniques,particularly endoscopic retrograde cholangiopancreatography(ERCP)and tissue sampling techniques play a key in establishing a diagnosis.Indeterminate biliary strictures(IDBSs)have no definite mass on imaging or absolute histopathological diagnosis and often warrant utilization of multiple diagnostics to ascertain an etiology.In this review,we discuss possible etiologies,clinical presentation,diagnosis,and management of IDBSs.Based on available data and expert opinion,we depict an evidence based diagnostic algorithm for management of IDBSs.Areas of focus include use of traditional tissue sampling techniques such as ERCP with brush cytology,intraductal biopsies,fluorescence in situ hybridization and flow cytometry.We also describe the role of endoscopic ultrasound(EUS)-guided fine needle aspiration and biopsies,cholangioscopy,confocal laser endomicroscopy,and intraductal EUS in management of IDBSs.

关 键 词：Biliary strictures Indeterminate strictures Biliary sampling CHOLANGIOSCOPY Benign strictures Malignant strictures Indeterminate biliary strictures 

分 类 号：R511[医药卫生—内科学] R575.7[医药卫生—临床医学]