OVERVIEW
Bile duct stenosis is a scarring narrowing of the lumen of the bile ducts due to bile duct injury and recurrent cholangitis or congenital. Bile duct stenosis can be caused by medical injury, abdominal trauma, and irritation from gallbladder stones, bile duct stones, and bile duct inflammation, resulting in fibrous tissue hyperplasia of the bile duct wall, thickening of the wall, and gradual narrowing of the lumen of the bile duct. Clinical manifestations include abdominal pain, chills, high fever, and intermittent jaundice. Antibiotic treatment is feasible in the early stage, but surgery is the fundamental treatment for this disease.
Causes
1. Lesions of the bile duct itself
(1) Congenital abnormality
(2) Inflammatory Commonly, after the ulceration of the wall of hepatic bile ducts caused by bile duct stones, the hepatoportal and intrahepatic bile ducts are predominant.
(3) Injurious Most of the injuries are of medical origin.
(4) Tumor: Most of them are cholangiocarcinoma.
(5) After liver transplantation In addition to bile duct anastomosis technique, it is mainly due to insufficient bile duct blood supply, which is related to prolonged cold ischemia during transplantation.
2. Lesions outside the bile duct
(1) Pancreatic lesions The distal part of bile duct is close to the head of pancreas, therefore, except pancreatic cancer can infiltrate the bile duct, chronic pancreatitis, especially autoimmune pancreatitis, can also involve the distal part of the bile duct, which can lead to poor bile drainage.
(2) Enlargement of hepatic-duodenal lymph nodes Gastric cancer and pancreatic head cancer can metastasize to lymph nodes in hepatic-duodenal ligament, thus compressing extrahepatic bile duct.
(3) Gallbladder cancer invading into the hepatoportal area and hepatoduodenal ligament.
Symptoms
Injurious bile duct stenosis With a history of biliary surgery, patients occasionally develop cholangitis with abdominal pain, chills, high fever and intermittent jaundice several months or 1-2 years after cholecystectomy, and then the intervals are gradually shortened and the symptoms become more and more serious. A few patients show painless jaundice or have developed biliary cirrhosis with portal hypertension.
Examination
1. Ultrasound
Ultrasonography is preferred for preoperative imaging, especially for patients with jaundice as the first symptom, and it is more sensitive to dilatation of intra- and extra-hepatic bile ducts or bile duct stones.
2. Retrograde cholangiopancreatography (ERCP)
ERCP is regarded as the gold standard for diagnosis of biliopancreatic system diseases, which can show the site and scope of bile duct stenosis, the degree of bile duct dilatation above the stenotic segment and stones more clearly, and can be performed at the same time with bile duct placement and drainage, which has the value of auxiliary treatment.
3.CT examination
CT scan can clearly show the dilatation of bile ducts and pneumatization, which has better diagnosis for bile duct dilatation and cholangitis.
4.Intravenous cholangiography
It can roughly show the rough condition of the bile duct. The common feature of the image is the dilatation of the bile duct above the narrowed segment. The image of intrahepatic bile duct stone is uneven distribution of contrast, slow and shallow development, stenosis; dilatation alternates, sometimes the contrast distribution is patchy.
Diagnosis
Diagnosis can be helped by history and clinical symptoms such as abdominal pain, chills, high fever, and intermittent jaundice, combined with imaging.
Treatment
1. General treatment
Effective control of biliary tract infection, high sugar and high protein diet to improve nutritional status; supplementation of energy combining agent and vitamin K, B, C to maintain the liver and systemic immune system.
2. Surgical treatment
Surgical treatment is the first choice for this disease. The principle of treatment is to remove the narrow scar lesion, repair and reconstruct the bile duct. The specific surgical method depends on the time of biliary obstruction, type and degree of stenosis, pathological state and the general condition of the patient. Mucosa-to-mucosa hepaticojejunal Roux-en-Y anastomosis has become the “gold standard” in the treatment of injurious biliary strictures, and is effective in most strictures.
Questions you may have
What is the best cure for bile duct stenosis?
There is no optimal cure for bile duct stenosis, which is usually treated with medication, interventional therapy, surgery and other therapeutic measures. According to the different conditions of patients, choose the appropriate cure.
1. Medication: If the stenosis is caused by general inflammation of the bile duct, anti-infective drugs (such as cefoperazone, moxifloxacin, etc.) can be used as prescribed by the doctor to treat the inflammation and make it return to the normal pathway. If the stenosis is due to inflammatory hyperplasia, biliary stenting or surgery can be considered.
2. Interventional therapy: If medication, cannot solve the problem of bile duct stenosis, consider interventional therapy, such as endoscopic placement of a stent, which can dilate the bile duct, thus achieving the purpose of treating the stenosis.
3. Surgery: If the bile duct stenosis is directly or indirectly caused by a tumor, bile duct reconstruction after radical surgical resection, such as pancreaticoduodenectomy, should be considered.
There are many causes of bile duct stenosis and many treatment options, which need to be under the guidance of a physician.