Differentiation of indeterminate biliary stricture

Preoperative evaluation of biliary strictures is problematic because of the risk of failing to detect a malignant tumor and the potential sequelae of unnecessary surgery in patients with strictures of benign origin. A stricture whose cause cannot be determined despite endoscopy, hematology, and imaging, including histological examination, is defined as an indeterminate biliary stricture. Imaging modalities-such as magnetic resonance imaging, magnetic resonance cholangiopancreatography, and multidetector computed tomography-play an important role in assessing the location, extent, length, and mass of the stricture. Early diagnosis of malignant strictures enables timely surgical intervention and administration of an appropriate chemotherapy regimen. However, no definitive diagnosis of malignant or benign strictures has been established. This chapter focuses on the causes of biliary strictures, and the blood tests, imaging studies, and endoscopic techniques that facilitate their diagnosis.