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How Best to Deal with Pancreato-Biliary Strictures?

How Best to Deal with Pancreato-Biliary Strictures?

21 Aug 2021 14:14 14:21
(7 mins)
Manu Tandan Speaker
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Endotherapy of Benign Biliary Strictures ERCP is the main method of Endoscopic management of Benign Biliary Strictures. EUS is a rapidly evolving technology and useful in cases where ERCP fails to achieve the goal. Interventional Radiology is useful when both the above techniques are not feasible and patients who are not relieved by any of these are sent for surgery. The commonest causes of Benign Biliary Strictures are Post Surgical (Post Cholecystectomy , Post Liver Transplant and Bilio-Enteric Anastamosis for any metabolic procedure. The methodology of managing BBS includes deep cannulation followed by Sphincterotomy and stenting. Single Plastic stents are no longer the standard of care for BBS. Multiple of maximal plastic stenting is advised in almost all patients. Multiple stents can be placed simultaneously or serially, off late fully covered SEMS have been extensively used in the management of BBS. These have shown to be as effective as multiple plastic stenting with the need of repeated interventions being less with SEMS. However migration remains a limitation. Newer anti migratory devices are being looked into. EUS with either anti-grade or retro-grade access to the Biliary system is advised if ERCP is not feasible. This should however be performed by experienced operators. The results of EUS guided stent placements are similar to PTBD by the Interventional radiologist.

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