Gastroenterology and Endoscopy Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Via F. Sforza 35, 20122 Milan, Italy.
Gastroenterology and Endoscopy Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Via F. Sforza 35, 20122 Milan, Italy; Digestive Endoscopy Unit, Fondazione IRCCS Policlinico San Matteo, Viale Camillo Golgi 19, 27100 Pavia, Italy.
Dig Liver Dis. 2020 Dec;52(12):1421-1427. doi: 10.1016/j.dld.2020.07.026. Epub 2020 Aug 29.
Post-operative biliary stricture is a cumbersome condition, secondary to biliary or vascular damage. Its risk factors include biliary or vascular anatomical variants, local inflammation, and poor surgical expertise. Intra-operative diagnosis is difficult, and in most cases, patients present with obstructive symptoms within a few weeks. Magnetic resonance cholangiography is a pivotal test to confirm the clinical picture, to study the level of the damage, and to guide treatment. Nowadays, endoscopic stenting is the first-line treatment in most centers. Multi-stenting treatment achieves long-term clinical success for more than 90% of patients, however multiple procedures are needed. In order to optimize healthcare provider costs, shorter duration endotherapies with covered metal stents are under evaluation. Radiological and surgical approaches are considered in the event of endoscopy failure.
术后胆道狭窄是一种棘手的情况，继发于胆道或血管损伤。其危险因素包括胆道或血管解剖变异、局部炎症和手术技术不佳。术中诊断困难，大多数情况下，患者在数周内出现梗阻症状。磁共振胆胰管成像（MRCP）是确认临床特征、研究损伤程度并指导治疗的关键检查。目前，内镜下支架置入术是大多数中心的一线治疗方法。多支架治疗使超过 90%的患者获得长期临床成功，但需要多次操作。为了优化医疗服务提供者的成本，具有覆盖金属支架的较短持续时间的内镜治疗正在评估中。如果内镜治疗失败，可考虑采用放射学和外科学方法。
