Clinical characteristics, risk factors and diagnostic outcomes of patients presented with indeterminate biliary stricture: A multicenter study

Mohammed Tag-Adeen; Mohamed Malak; Muhammad Abdel-Gawad; Ahmed Abu-Elfatth; Ramadan H Eldamarawy; Ahmed Alzamzamy; Mohamed Elbasiony; Ramy M Elsharkawy; Fathiya El-Raey; Ahmed N Basiony; Ahmed Qasem; Zakarya Shady; Ahmed S Abdelmohsen; Doaa Abdeltawab; Mahmoud Farouk; Ola M Fouad; Ahmed Rabie; Abdul-Hakim Erian; Ahlam Sapra; Wael Shaibat-Alhamd; Ashraf Aboubakr; Dalia Omran; Mohamed Alboraie

doi:10.3389/fmed.2022.1018201

Clinical characteristics, risk factors and diagnostic outcomes of patients presented with indeterminate biliary stricture: A multicenter study

Front Med (Lausanne). 2023 Jan 9:9:1018201. doi: 10.3389/fmed.2022.1018201. eCollection 2022.

Authors

Mohammed Tag-Adeen¹, Mohamed Malak², Muhammad Abdel-Gawad³, Ahmed Abu-Elfatth⁴, Ramadan H Eldamarawy⁵, Ahmed Alzamzamy⁶, Mohamed Elbasiony⁷, Ramy M Elsharkawy⁸, Fathiya El-Raey⁹, Ahmed N Basiony¹⁰, Ahmed Qasem³, Zakarya Shady⁵, Ahmed S Abdelmohsen⁴, Doaa Abdeltawab⁴, Mahmoud Farouk⁴, Ola M Fouad¹, Ahmed Rabie¹¹, Abdul-Hakim Erian¹, Ahlam Sapra¹, Wael Shaibat-Alhamd¹², Ashraf Aboubakr⁶, Dalia Omran¹³, Mohamed Alboraie⁵

Affiliations

¹ Division of Gastroenterology and Hepatology, Department of Internal Medicine, Qena Faculty of Medicine, South Valley University, Qena, Egypt.
² Division of Gastroenterology and Hepatology, Department of Internal Medicine, Faculty of Medicine, Sohag University, Sohag, Egypt.
³ Hepatology, Gastroenterology, and Infectious Diseases, Al-Azhar University, Assiut, Egypt.
⁴ Department of Tropical Medicine and Gastroenterology, Assuit University, Assiut, Egypt.
⁵ Department of Internal Medicine, Al-Azhar University, Cairo, Egypt.
⁶ Department of Gastroenterology and Heptology, Maadi Armed Forces Medical Complex, Military Medical Academy, Cairo, Egypt.
⁷ Division of Gastroenterology and Hepatology, Department of Internal Medicine, Faculty of Medicine, Mansoura University, Mansoura, Dakahlya, Egypt.
⁸ Department of Tropical Medicine and Gastroenterology, Faculty of Medicine, Sohag University, Sohag, Egypt.
⁹ Department of Hepatogastroenterology and Infectious Diseases, Al-Azhar University, Damietta, Egypt.
¹⁰ Department of Tropical Medicine, Ain Shams University, Cairo, Egypt.
¹¹ Department of Pathology, Faculty of Medicine, Al-Azhar University, Damietta, Egypt.
¹² Division of Gastroenterology and Hepatology, Department of Internal Medicine, Al-Azhar Faculty of Medicine, Al-Azhar University, Assiut, Egypt.
¹³ Department of Endemic Medicine and Hepatology, Faculty of Medicine, Cairo University, Giza, Egypt.

Abstract

Background and aim: Indeterminate biliary stricture (IBS) is a frequently encountered clinical problem. In this study, we aimed to highlight the clinical characteristics, risk factors and diagnostic outcomes of patients presented with indeterminate biliary stricture.

Method: A Retrospective multicenter study included all patients diagnosed with IBS in the participating centers between 2017 and 2021. Data regarding IBS such as presentations, patient characteristics, diagnostic and therapeutic modalities were collected from the patients' records and then were analyzed.

Results: Data of 315 patients with IBS were retrospectively collected from 7 medical centers with mean age: 62.6 ± 11 years, females: 40.3% and smokers: 44.8%. For diagnosing stricture; Magnetic resonance imaging/Magnetic resonance cholangiopancreatography (MRI/MRCP) was the most frequently requested imaging modality in all patients, Contrast enhanced computerized tomography (CECT) in 85% and endoscopic ultrasound (EUS) in 23.8%. Tissue diagnosis of cholangiocarcinoma was achieved in 14% only. The used therapeutic modalities were endoscopic retrograde cholangiopancreatography (ERCP)/stenting in 70.5%, percutaneous trans-hepatic biliary drainage (PTD): 17.8%, EUS guided drainage: 0.3%, and surgical resection in 8%. The most frequent type of strictures was distal stricture in 181 patients, perihilar in 128 and intrahepatic in 6. Distal strictures had significant male predominance, with higher role for EUS for diagnosis and higher role for ERCP/stenting for drainage, while in the perihilar strictures, there was higher role for CECT and MRI/MRCP for diagnosis and more frequent use of PTD for drainage.

Conclusion: Indeterminate biliary stricture is a challenging clinical problem with lack of tissue diagnosis in most of cases mandates an urgent consensus diagnostic and treatment guidelines.

Keywords: CECT; ERCP; MRCP; MRI; biliary stricture; cholangiocarcinoma (CCA).

Copyright © 2023 Tag-Adeen, Malak, Abdel-Gawad, Abu-Elfatth, Eldamarawy, Alzamzamy, Elbasiony, Elsharkawy, El-Raey, Basiony, Qasem, Shady, Abdelmohsen, Abdeltawab, Farouk, Fouad, Rabie, Erian, Sapra, Shaibat-Alhamd, Aboubakr, Omran and Alboraie.