Diagnostic Approach to Indeterminate Biliary Stricture / 대한췌담도학회지

ABSTRACT

Accurate diagnosis of biliary strictures is challenging and it commonly necessitates a multidisciplinary approach. There has been a great advancement of endoscopic techniques in tissue acquisition, laboratory tests, and imaging studies. Indeterminate biliary strictures are defined as strictures of no identifiable etiology despite extensive evaluation. Imaging modalities such as magnetic resonance imaging, magnetic resonance cholangiopancreatography, multi-detector computed tomography play a great role in evaluating the level, degree, length of biliary strictures and presence of a mass. Early and accurate diagnosis as malignant stricture can determine not only optimal timing of surgery, but also potential timely chemotherapy. No assertive diagnostic modalities to distinguish benign from malignant strictures is yet established. This article reviews various etiologies of biliary strictures and discusses the laboratory evaluation, imaging modalities and promising endoscopic work-up with biopsy to improve the diagnostic sensitivity.