Pathophysiology
Extension of inflammation into peripancreatic tissues
Involve CBD, duodenum, colon, Portal vein, Splenic vein
To be distinguished from compression caused by pseudocysts

Bile duct stricture
Equal incidence in alcoholic & non-alcoholic Chronic Pancreatitis
Higher incidence in CP with inflammatory head mass

Bile duct stricture Complications
Cholangitis 6%-15% of stricture patients
Biliary cirrhosis- 3% to 10%
Liver fibrosis
 Common -up to 73%
 Not evaluated often
 Reduction after decompression

Management options
Endoscopic stenting
Technically possible nearly in all
Risk of stent block & cholangitis
Regular change mandatory with plastic stents
Better results with metallic stents

Results with metallic stents
Most patients with metallic stents will develop recurrent cholangitis or stent obstruction
Chronic inflammation and obstruction may predispose the patient to cholangiocarcinoma

Surgical options
Choledochoduodenostomy
Choledochojejunostomy
Cholecystoduodenostomy
Cholecystojejunostomy
T-tube drainage
Resectional procedures

Surgical procedures have,
Higher initial post procedure risk
Acceptable morbidity in the majority
Near zero mortality
Excellent long term results

Stenting vs surgery
Initial therapy before surgery
Can be the definitive approach for older and morbid patients
Should not be considered as a routine procedure for symptomatic cases

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