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Title: Focal intrahepatic strictures: a review of diagnosis and management.
Austin Authors: Yeo, David;Perini, Marcos Vinicius;Muralidharan, Vijayaragavan ;Christophi, Christopher 
Affiliation: University of Melbourne Department of Surgery, Austin Health, Heidelberg, Victoria, Australia
Issue Date: 1-Jul-2012
Publication information: Hpb : the Official Journal of the International Hepato Pancreato Biliary Association; 14(7): 425-34
Abstract: Focal intrahepatic strictures are becoming more common owing to more prevalent and accurate cross-sectional imaging. However, data relating to their management are lacking. The purpose of the present review was to synthesize the current evidence regarding these lesions and to formulate a strategy for diagnosis and management.A literature search of relevant terms was performed using Medline. References of papers were subsequently searched to obtain older literature.Focal intrahepatic strictures involve segmental hepatic ducts and/or left and right main hepatic ducts during their intrahepatic course. Most patients are asymptomatic while the minority present with vague abdominal pain or recurrent sepsis and only rarely with jaundice. Investigations used to distinguish benign from malignant aetiologies include blood tests (CEA, Ca19.9), imaging studies [ultrasonography (US), computed tomography (CT), magnetic resonance cholangiopancreatography (MRCP) and fluorodeoxyglucose-positron emission tomography (FDG-PET)], endoscopic modalities [endoscopic retrograde cholangiopancreatography (ERCP)/endoscopic ultrasound (EUS)/cholangioscopy] and tissue sampling (brush cytology/biopsy).A focal intrahepatic stricture requires thorough investigation to exclude malignancy even in patients with a history of biliary surgery, hepatolithiasis or parasitic infection. If during the investigative process a diagnosis or suspicion of malignancy is demonstrated then surgical resection should be performed. If all diagnostic modalities suggest a benign aetiology, then cholangioscopy with targeted biopsies should be performed.
Gov't Doc #: 22672543
DOI: 10.1111/j.1477-2574.2012.00481.x
Type: Journal Article
Subjects: Animals
Bile Ducts, Intrahepatic.pathology
Biological Markers.blood
Cholestasis, Intrahepatic.diagnosis.epidemiology.pathology.therapy
Constriction, Pathologic
Diagnostic Imaging
Predictive Value of Tests
Risk Factors
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