Common controversies in management of biliary strictures

Core Tip

Core tip: Based on available evidence preoperative biliary drainage is not routinely indicated in resectable malignant strictures. However, it is appropriate in acute cholangitis, in severely symptomatic patients and in those with delayed surgery. In patients with unresectable hilar stricture, cross-sectional imaging is advised prior to attempt at palliative drainage. In such patients unilateral stenting during endoscopic retrograde cholangiopancreatography is adequate in most cases. Routine stenting of dominant strictures in primary sclerosing cholangitis patients is not recommended. Stenting of dominant strictures is appropriate if there is poor drainage of contrast after dilatation or concern for collapse of the bile duct compromising biliary drainage.