Management and Imaging of Biliary Strictures

Targeted CE per ARRT’s Discipline, Category, and Subcategory classification for enrollments starting after January 27, 2023:
[Note: Discipline-specific Targeted CE credits may be less than the total Category A credits approved for this course.]

Computed Tomography: 1.75
Procedures: 1.75
Abdomen and Pelvis: 1.75

Magnetic Resonance Imaging: 1.00
Procedures: 1.00
Body: 1.00

Registered Radiologist Assistant: 2.75
Procedures: 2.75
Abdominal Section: 2.75

Sonography: 1.00
Procedures: 1.00
Abdomen: 1.00

Vascular-Interventional Radiography: 2.75
Procedures: 2.75
Nonvascular Procedures: 2.75

Outline

1. Introduction
2. Etiology
   1. Classifications
   2. Clinical Presentation
3. Imaging Diagnosis of Biliary Strictures
   1. Percutaneous Transhepatic Cholangiography
4. Management of BBSs
   1. Balloon Dilation
   2. Maintained Large-Bore Catheter
   3. Stent Placement
5. Management of MBSs
   1. Medical and Surgical Options
   2. Preoperative Biliary Drainage
      1. Success and Route of Biliary Drainage
      2. Complications of Biliary Drainage
   3. Stent Placement
   4. Complications of Metal Stents for MBS
   5. Investigational Strategies

Objectives

Upon completion of this course, students will:

1. identify treatment techniques for benign biliary strictures
2. identify the main goals to management of biliary strictures
3. discuss reasons for reintervention after stent placement for MBSs
4. identify iatrogenic causes of benign biliary strictures
5. describe extrinsic causes of malignant biliary strictures
6. identify commonalities between the biliary stricture classification systems
7. describe the clinical symptoms of malignant biliary obstruction of the distal bile duct
8. identify factors which limit ultrasound in the detection of biliary strictures
9. describe the imaging features of malignant biliary strictures on CT
10. describe the imaging features of benign biliary strictures on MRCP
11. discuss imaging modalities used to detect biliary obstructions
12. identify access areas which are commonly used by interventional radiologists
13. discuss the complications of PTHC
14. identify appropriate biliary duct access points for PTHC and biliary drainage
15. describe appropriate management of bilioenteric anastomotic strictures
16. identify treatment options for benign biliary strictures which do not respond to standard balloon dilation
17. describe the advantages of covered self-expanding stents in the treatment of benign biliary strictures
18. identify advantages of biodegradable stents in the treatment of benign biliary strictures
19. identify patients who would benefit from minimally invasive palliative decompressive therapy and medical treatment of malignant biliary strictures
20. discuss the use of preoperative biliary drainage in patients with infectious cholangitis
21. compare the indications of percutaneous transhepatic biliary drainage (PTBD) to endoscopic biliary drainage
22. identify the common source of bleeding after PTBD
23. describe the clinical signs of arterial injury during or after PTBD
24. discuss the cause of electrolyte imbalances in patients with external biliary catheter drainage
25. identify the goals of palliative stent placement in patients with malignant biliary strictures
26. identify the common causes of inoperable malignant biliary obstruction
27. discuss imaging modalities used to image obstructed biliary ducts prior to stent placement
28. identify the reasons to leave an internal-external biliary drain after self-expanding metal stent placement
29. select the preferred stent for treatment of hilar obstruction
30. describe modifications made to covered self-expanding metal stents to reduce stent migration
31. discuss techniques for reducing cholangitis after stent placement
32. identify the complication of contrast injection into the pancreatic duct
33. describe the causes of acute cholecystitis after stent placement
34. discuss the causes of acute recurrent obstruction after stent placement
35. identify strategies currently under investigation for treatment of malignant biliary strictures