Indeterminate Biliary Stricture

Biliary obstruction results from diverse benign and malignant processes that can be challenging to diagnose accurately. When biliary obstruction is identified, an efficient approach to early diagnostic testing and management is important for reduction of morbidity and guidance of definitive therapy. The assessment and management of patients with indeterminate biliary strictures begins with characterizing the pathogenesis of the stricture by employing historical features, laboratory testing, and noninvasive and invasive imaging and using various tissue sampling methods. Stricture characterization and relief of obstruction are not independent pursuits but are typically accomplished in unison, most commonly via endoscopic retrograde cholangiopancreatoscopy (ERCP) and/or percutaneous means.