Guidelines on the diagnosis and management of biliary strictures were published in March 2023 by the American College of Gastroenterology (ACG) in The American Journal of Gastroenterology.[1] They provide guidance on the care of patients with extrahepatic and perihilar strictures. These guidelines are considered separate from the 2015 ACG guidelines related to primary sclerosing cholangitis. Strong recommendations and select conditional recommendations are outlined below.
A definitive tissue diagnosis is necessary to guide oncologic and endoscopic care for most strictures that aren’t surgically resectable at the time of presentation.
Biliary strictures in adults are more likely to be malignant than benign, except in certain well-defined scenarios. A high index of clinical suspicion during evaluation is essential.