Biliary and Pancreatic Duct Strictures

What are biliary and pancreatic duct strictures?

A duct is a tube through which something passes. On its way to the small intestine, bile from the liver and gallbladder passes through a bile duct. Digestive enzymes and fluids from the pancreas, headed in the same direction, pass through the pancreatic duct. Sometimes the ducts through which these fluids pass narrow so much, because of scarring or other blockage, that it impedes the flow of the digestive fluids. The area of narrowing is called a stricture. Bile duct and pancreatic duct strictures can be caused by trauma to the abdomen, an inflammatory disorder called sclerosing cholangitis, stones, radiation treatment, tumors, surgery, or infections. Both bile and digestive enzymes are important for digestion, and their blockage can be painful and cause serious gastroenterological problems. 

What are the symptoms of biliary and pancreatic duct strictures?

The symptoms of a stricture depend on its location. If it is in the bile duct, a child’s skin and eyes may yellow (a condition called jaundice), and he or she may experience pain on the upper-right side of the abdomen. If the pancreatic duct is blocked, in addition to pain and jaundice, a child may also experience diarrhea and loss of appetite.

How do we treat biliary and pancreatic strictures?

Both biliary and pancreatic strictures can usually be treated using a minimally invasive procedure called endoscopic retrograde cholangiopancreatography. ERCP, as it is abbreviated, is usually an outpatient procedure conducted under anesthesia. An endoscope is inserted into the patient’s mouth and guided down the esophagus through the stomach and into the duodenum to the area called the major papilla, where the pancreatic and biliary ducts enter the duodenum. A guide wire and catheter are inserted through the major papilla and into the ducts. Using fluoroscopy, dye is injected so that the doctor can see on an x-ray the cause of blockage or other problems and then deliver the appropriate treatment. Treatment options include stricture dilations with a balloon or rigid dilator, stent insertion, or, if the stricture is caused by a stone, the removal of it.