title: The current diagnosis and treatment of benign biliary stricture.
abstract: OBJECTIVE
  As laparoscopic cholecystectomy and liver transplantation (LT) have become more common, so has biliary stricture. Fortunately, endoscopic treatment has almost simultaneously been developed. This article reviews the recent reports concerning the management of benign biliary strictures (BBS).
  
  
  METHODS
  The literature regarding the diagnosis and treatment of BBS is reviewed after an electronic search of PubMed from 1982 to 2009 was performed.
  
  
  RESULTS
  Despite the existence of diagnostic tools including tumor markers, brush cytology, intraductal ultrasonography and other imaging modalities, differentiating BBS from malignant stricture remains challenging, as does differentiating IgG4-related sclerosing cholangitis from other benign strictures. Endoscopic treatment with balloon dilation of the stricture and serial insertions of stents is the preferred initial treatment for BBS. However, the outcomes of endoscopic treatments for primary sclerosing cholangitis or chronic pancreatitis are poorer than those for post-surgical biliary stricture. When endoscopic treatments fail to repair complicated biliary strictures such as Bismuth types III, IV, and V, surgical repair is recommended. Among the non-anastomotic BBS, intrahepatic bilateral type strictures after LT may require repeat transplantation.
  
  
  CONCLUSIONS
  Early referral to tertiary centers with an alliance among hepatobiliary surgeons, interventional radiologists, and endoscopists is necessary to assure optimal results.
authors.affiliation: Medical Division, Japan Labor, Health, and Welfare Organization, Kawasaki-shi, Japan. hs440312@yahoo.co.jp
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Shimada
authors.forename: Itaru
authors.initials: I
authors.lastname: Endo
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Shimada
authors.forename: Ryusei
authors.initials: R
authors.lastname: Matsuyama
authors.forename: Noritoshi
authors.initials: N
authors.lastname: Kobayashi
authors.forename: Kensuke
authors.initials: K
authors.lastname: Kubota
mesh_terms: D000714:Anastomosis, Surgical / Q000009:adverse effects; D001650:Bile Duct Neoplasms / Q000175:diagnosis; D001652:Bile Ducts / Q000601:surgery; D015209:Cholangitis, Sclerosing / Q000150:complications; D017081:Cholecystectomy, Laparoscopic / Q000009:adverse effects; D002779:Cholestasis / Q000175:diagnosis* / Q000209:etiology / Q000628:therapy*; D003937:Diagnosis, Differential; D003952:Diagnostic Imaging / Q000379:methods; D004106:Dilatation / Q000379:methods; D016145:Endoscopy, Digestive System / Q000379:methods*; D006801:Humans; D007049:Iatrogenic Disease; D016031:Liver Transplantation / Q000009:adverse effects; D050500:Pancreatitis, Chronic / Q000150:complications; D015607:Stents; D016896:Treatment Outcome