OMED E-Newsletter Issue 7, 2009: NYSGE Syllabus
Approach to Biliary Strictures
By Douglas A. Howell, M.D.
The New York Society for Gastrointestinal Endoscopy is the largest regional GI endoscopy society in the United States. The Society is dedicated to the teaching and advancement of gastrointestinal endoscopy. The society runs numerous programs throughout the year, including an annual fellow’s endoscopy course each summer, and a major postgraduate endoscopy conference each fall. The next course will be held in New York from December 16-19, 2009.
Each month a syllabus entry from the 32nd Annual New York Society for Gastrointestinal Endoscopy Course can be accessed here. This month the entry is entitled ‘Approach to Biliary Strictures’ by Douglas A. Howell, M.D.
Biliary strictures represent a challenge and opportunity for endoscopists both diagnostically and therapeutically.
When confronting a biliary stricture, both benign and malignant etiologies must be carefully considered.
Benign causes include:
- Primary sclerosing cholangitis
- Post-operativeTraumatic
- Cystic duct stone impaction (Mirizzi) syndrome
- Compression from adjacent inflammatory disease (i.e., pancreatitis)
- Autoimmune pancreatitis
Malignant etiologies include:
- Pancreatic carcinoma
- Primary cholangiocarcinoma
- Gallbladder cancer
- Metastatic disease
At initial evaluation multiple questions must be answered before an approach to a diagnosis and treatment can be advanced.
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