Proximal biliary strictures: using PTC endobiliary biopsy to avoid unnecessary surgical exploration. The Queen Elizabeth Birmingham experience.

Proximal biliary strictures (PBS) are located at the liver hilum or within the proximal third of the extrahepatic bile duct. Patients with these lesions are most likely to present with painless jaundice and a blood profile consistent with biliary obstruction. The majority of proximal biliary strictures are due to cholangiocarcinoma; however 10-25% are related to benign disease or other malignancies such as metastatic lymph nodes or lymphoma. These entities can mimic the clinical and radiological findings of cholangio-carcinoma and herein lies a diagnostic dilemma: while a treatable cholangiocarcinoma requires complex hepatobiliary surgical resection, other malignant lesions and benign proximal biliary strictures should not be treated surgically. It is therefore common practice to perform tissue sampling in the management pathways of these patients, minimising the occurrence of unnecessary surgery.

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