Bile duct stricture is a narrowing of the bile ducts, the tubes that drain the liver into the small intestine. A stricture can occur in the ducts within the liver (intrahepatic ducts) or in the ducts that connect the liver to the small intestine (common hepatic duct and common bile duct).
A stricture may be benign and related to scarring from previous surgery or an uncommon condition call primary sclerosing cholangitis (see separate discussion). It may also be malignant due to a cancerous growth arising from the cells that line the bile duct (cholangiocarcinoma) or from a cancerous growth in an adjacent organ compressing the duct, most commonly pancreatic cancer.
Cancerous growths within the liver or the lymph nodes beneath the liver can also cause obstruction of the bile ducts. The diagnosis is suspected when blood tests reveal abnormally elevated liver enzymes and an imaging study such as ultrasound, CT scan, or MRI scan demonstrates swelling or dilatation of the bile ducts above the narrowed duct.
The obstruction rarely causes pain but frequently causes yellowing of the eyes and skin (jaundice) and itching.
The diagnosis can be confirmed by performing an MRI scan of the bile ducts (MRCP) which will demonstrate an area of obstruction. Endoscopic Retrograde Cholangiopancreatography (ERCP) can also be performed to confirm the diagnosis, obtain biopsies and relieve the obstruction.
A stricture can be treated during ERCP by inflating a balloon in the area that is narrowed. A plastic or metal stent may also be placed temporarily to prevent the stricture from recurring. A persistent or recurring stricture may require surgery.