Biliary Strictures and Leaks

Biliary leaks and strictures are commonly encountered clinical problems in gastroenterology. Bile leaks are most commonly due to iatrogenic duct injury during laparoscopic cholecystectomy which occurs at a rate of approximately 3%. Bile leaks can usually be treated endoscopically by performing a sphincterotomy and the placement of a biliary stent. Patients with refractory leaks or complete transection of the bile duct require surgical management. Biliary strictures occur due to a variety of mechanisms including iatrogenic, inflammatory and neoplastic causes. Endoscopic biliary dilatation and stenting is the mainstay of therapy for biliary strictures. Malignant biliary strictures and those refractory to endoscopic therapy may require surgical intervention.