Bile Duct Strictures

What are Bile Duct Strictures?

The bile duct transports bile from the liver to the gallbladder for storage, and from the gallbladder through the pancreas and into the small intestine when it is required for digestion. Bile is essential for digestion because it helps to break down fats and aids in the removal of waste products.

Bile duct strictures, also known as bile duct obstructions, are the narrowing or blockage of the bile ducts, which then slows down or completely disrupts the transportation of bile from the liver to the gallbladder and beyond. Strictures of the bile duct could be due to either malignant or benign lesions.

What are the common causes?

Bile duct strictures are either congenital (you were born with it) or acquired, and as mentioned, may be malignant or benign in nature.

These are the causes of bile duct strictures:

Injury to the bile duct: this could happen during gallbladder removal surgery.
Blockage: gallbladder stones that form in the gallbladder may travel through the bile duct and get stuck in it; they are subsequently known as bile duct stones. If there is a bile duct stone blocking the bile duct, bile will not be able to exit and travel to the necessary areas.
Bile duct infection: an infection could cause the bile duct to become inflamed and swollen causing it to narrow.
Cancer: malignant in nature, a tumour could be big enough to cause the bile ducts to narrow, thus preventing the seamless flow of bile.
Pancreatitis: inflammation of the pancreas may cause an obstruction to the bile duct.

What are the common symptoms?

When bile is unable to travel from the liver to the small intestine, it builds up in the liver and causes bilirubin (formed when red blood cells are broken down) to leak into your blood. Since bile is unable to reach the small intestine, the food that you eat will not be digested properly which then affects the absorption of nutrients.
The following symptoms are the result of the chain reaction previously mentioned:

Pale or light-coloured stools
Pain in the upper right side of your abdomen
Fever
Nausea

Vomiting
Unintentional weight loss
Loss of appetite
Lethargy or fatigue

Are Bile Duct Strictures painful?

Yes, this is especially true if your bile duct stricture is caused by blockage from a gallstone, also known as a bile duct stone since it is stuck in the bile duct.

Who is at risk of Bile Duct Strictures in Singapore?

Individuals who are at risk are often also at risk of gallstones since gallstones or bile duct stones and their related surgical treatment options are one of the causes of bile duct strictures. These risk factors are:

Age: increasing age results in increasing risk of gallbladder/bile duct stones and bile duct strictures.
Weight: overweight individuals are at a higher risk of gallbladder/bile ducts stones and bile duct strictures due to other associated conditions such as insulin resistance, high blood pressure, high cholesterol.
Unhealthy lifestyle: diets high in refined sugars and fat and low in fibre, coupled with a lack of exercise, increases your risk of gallbladder/bile duct stones and bile duct strictures.

Pregnancy: increased oestrogen during pregnancy increases cholesterol and reduces emptying of the gallbladder, which increases the risk of gallstones/bile duct stones and bile duct strictures.
Family history: having a relative with gallbladder/bile duct stones increases your risk which ultimately increases your risk of bile duct strictures.
Other medical conditions: liver cirrhosis, bariatric surgery, type 2 diabetes, high cholesterol, etc. increases your risk of gallbladder/bile duct stones and bile duct strictures.

How are Bile Duct Strictures diagnosed?

If you are experiencing bile duct stricture related symptoms, your gastroenterologist may conduct the following tests to make a diagnosis4:

Blood tests: checks for bilirubin and enzyme levels.
Ultrasound: sound waves are used to produce images of the structures within your body. An ultrasound is the first line of defense for the hepatobiliary system which is made up of the liver, gall bladder, and the bile ducts. It is a non-invasive procedure used to identify any anomalies within the hepatobiliary system.
Computed tomography scans (CT-scans): non-invasive diagnostic imaging tool that uses a combination of x-rays and computer technology to produce cross-sectional, horizontal, or axial images of the body.
Magnetic resonance cholangio-pancreatography (MRCP): used to confirm the presence of a bile duct stricture.
Endoscopic retrograde cholangio-pancreatography (ERCP): combination of x-rays and an upper gastrointestinal tract endoscopy to identify or treat problems with the pancreatic or bile ducts.

What are the available treatment options for Bile Duct Strictures in Singapore?

Treatment for bile duct strictures is as follows:

ERCP: used to insert a biliary stent into the bile duct to remove or the blockage e.g., remove bile duct stones.
Percutaceous transhepatic cholangiography (PTHC): a needle or catheter is inserted into your abdomen and into the bile duct, this will help to drain the bile out.

Your treatment will be based on the cause of your bile duct stricture.

Frequently asked questions

What percentage of bile duct strictures are malignant?

The majority (76-85%) of bile duct strictures are malignant.

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General

Liver

Oesophagus

Biliary/Pancreas

Stomach/Duodenum

Intestinal