Biliary Obstruction: A Multidisciplinary Diagnostic and Therapeutic Approaches
Abstract
Background: Biliary obstruction is a significant clinical condition characterized by impaired bile flow from the liver to the duodenum, leading to systemic and gastrointestinal complications. It is associated with high morbidity and mortality, particularly when complicated by infection or organ dysfunction.
Aim: To review the multidisciplinary diagnostic and therapeutic approaches for biliary obstruction, emphasizing etiology, epidemiology, pathophysiology, evaluation, and management strategies.
Methods: This comprehensive review synthesizes current evidence from clinical studies, imaging modalities, and interventional techniques. It examines anatomical, biochemical, and histopathologic aspects of obstruction and evaluates diagnostic algorithms integrating laboratory, radiologic, and endoscopic methods.
Results: Gallstones remain the most common cause of extrahepatic obstruction globally, while malignant etiologies such as cholangiocarcinoma and pancreatic cancer carry the highest mortality. Imaging modalities like ultrasonography and MRCP are first-line tools, while ERCP serves both diagnostic and therapeutic roles. Management strategies vary by etiology: endoscopic stone extraction and cholecystectomy for gallstones, stenting and oncologic intervention for malignancy, and surgical reconstruction for congenital anomalies. Early recognition and multidisciplinary coordination significantly improve outcomes.
Conclusion: Timely diagnosis and etiology-specific intervention are critical to reducing complications such as cholangitis, sepsis, and secondary biliary cirrhosis. A structured, team-based approach integrating gastroenterology, surgery, radiology, and oncology optimizes patient outcomes.
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References
Hundt M, Basit H, John S. Physiology, Bile Secretion. StatPearls. 2024 Jan
Pavlidis ET, Pavlidis TE. Pathophysiological consequences of obstructive jaundice and perioperative management. Hepatobiliary & pancreatic diseases international : HBPD INT. 2018 Feb:17(1):17-21. doi: 10.1016/j.hbpd.2018.01.008.
Kruis T, Güse-Jaschuck S, Siegmund B, Adam T, Epple HJ. Use of microbiological and patient data for choice of empirical antibiotic therapy in acute cholangitis. BMC gastroenterology. 2020 Mar 12:20(1):65. doi: 10.1186/s12876-020-01201-6.
Siddiqui AI, Ahmad T. Biliary Atresia. StatPearls. 2024 Jan
Kamal F, Williams G, Akbar H, Khan MA, Kadaria D. Klebsiella Pneumoniae Liver Abscess: a Case Report and Review of Literature. Cureus. 2017 Jan 10:9(1):e970. doi: 10.7759/cureus.970.
Taylor T, Wheatley M, Gupta N, Nusbaum J. Jaundice in the emergency department: meeting the challenges of diagnosis and treatment [digest]. Emergency medicine practice. 2018 Apr 2:20(Suppl 4):1-2
Zhang W, Wang BY, Du XY, Fang WW, Wu H, Wang L, Zhuge YZ, Zou XP. Big-data analysis: A clinical pathway on endoscopic retrograde cholangiopancreatography for common bile duct stones. World journal of gastroenterology. 2019 Feb 28:25(8):1002-1011. doi: 10.3748/wjg.v25.i8.1002.
Stinton LM, Myers RP, Shaffer EA. Epidemiology of gallstones. Gastroenterology clinics of North America. 2010 Jun:39(2):157-69, vii. doi: 10.1016/j.gtc.2010.02.003.
Rebholz C, Krawczyk M, Lammert F. Genetics of gallstone disease. European journal of clinical investigation. 2018 Jul:48(7):e12935. doi: 10.1111/eci.12935.
Njeze GE. Gallstones. Nigerian journal of surgery : official publication of the Nigerian Surgical Research Society. 2013 Jul:19(2):49-55. doi: 10.4103/1117-6806.119236.
Verweij KE, van Buuren H. Oriental cholangiohepatitis (recurrent pyogenic cholangitis): a case series from the Netherlands and brief review of the literature. The Netherlands journal of medicine. 2016 Nov:74(9):401-405
Heedman PA, Åstradsson E, Blomquist K, Sjödahl R. Palliation of Malignant Biliary Obstruction: Adverse Events are Common after Percutaneous Transhepatic Biliary Drainage. Scandinavian journal of surgery : SJS : official organ for the Finnish Surgical Society and the Scandinavian Surgical Society. 2018 Mar:107(1):48-53. doi: 10.1177/1457496917731192.
Goldberg DM. Structural, functional, and clinical aspects of gamma-glutamyltransferase. CRC critical reviews in clinical laboratory sciences. 1980:12(1):1-58
Schiff ER. Cholestatic evaluation. Laboratory and research methods in biology and medicine. 1983:7():517-28
Wyatt SH, Fishman EK. Biliary tract obstruction. The role of spiral CT in detection and definition of disease. Clinical imaging. 1997 Jan-Feb:21(1):27-34
Padilla RM, Hulsberg PC, Soule E, Harmon TS, Eadie E, Hood P, Shabandi M, Matteo J. Against the Odds: A Novel Technique to Perform Cholangiography from a Percutaneous Approach through the Cystic Duct. Cureus. 2018 Nov 12:10(11):e3577. doi: 10.7759/cureus.3577.
Sarin SK, Choudhury A. Management of acute-on-chronic liver failure: an algorithmic approach. Hepatology international. 2018 Sep:12(5):402-416. doi: 10.1007/s12072-018-9887-5.
Della Penna A, Lange J, Hilbert J, Archid R, Königsrainer A, Quante M. Ursodeoxycholic Acid for 6 Months After Bariatric Surgery Is Impacting Gallstone Associated Morbidity in Patients with Preoperative Asymptomatic Gallstones. Obesity surgery. 2019 Apr:29(4):1216-1221. doi: 10.1007/s11695-018-03651-0.
Nabi Z, Reddy DN. Endoscopic Management of Combined Biliary and Duodenal Obstruction. Clinical endoscopy. 2019 Jan:52(1):40-46. doi: 10.5946/ce.2018.102.
Beyna T, Gerges C. Clinical Management of Bile Duct Diseases: Role of Endoscopic Ultrasound in a Personalized Approach. Journal of personalized medicine. 2020 Dec 22:11(1):. doi: 10.3390/jpm11010001.
Yılmaz S, Akıcı M, Şimşek M, Okur N, Erşen O, Tuncer AA. Endoscopic retrograde cholangiopancreatography for biliary system parasites. Turkish journal of surgery. 2018 Jan 3:34(4):306-310. doi: 10.5152/turkjsurg.2017.3808.
Sharma M, Somani P. EUS of pancreatic ascariasis. Arab journal of gastroenterology : the official publication of the Pan-Arab Association of Gastroenterology. 2018 Mar:19(1):47-48. doi: 10.1016/j.ajg.2018.02.011.
Friedmacher F, Ford KE, Davenport M. Choledochal malformations: global research, scientific advances and key controversies. Pediatric surgery international. 2019 Mar:35(3):273-282. doi: 10.1007/s00383-018-4392-4.
Nagino M, Hirano S, Yoshitomi H, Aoki T, Uesaka K, Unno M, Ebata T, Konishi M, Sano K, Shimada K, Shimizu H, Higuchi R, Wakai T, Isayama H, Okusaka T, Tsuyuguchi T, Hirooka Y, Furuse J, Maguchi H, Suzuki K, Yamazaki H, Kijima H, Yanagisawa A, Yoshida M, Yokoyama Y, Mizuno T, Endo I. Clinical practice guidelines for the management of biliary tract cancers 2019: The 3rd English edition. Journal of hepato-biliary-pancreatic sciences. 2021 Jan:28(1):26-54. doi: 10.1002/jhbp.870.
Clemente G, Tringali A, De Rose AM, Panettieri E, Murazio M, Nuzzo G, Giuliante F. Mirizzi Syndrome: Diagnosis and Management of a Challenging Biliary Disease. Canadian journal of gastroenterology & hepatology. 2018:2018():6962090. doi: 10.1155/2018/6962090.
Janmohamed A, Trivedi PJ. Patterns of disease progression and incidence of complications in primary biliary cholangitis (PBC). Best practice & research. Clinical gastroenterology. 2018 Jun-Aug:34-35():71-83. doi: 10.1016/j.bpg.2018.06.002.
Authors
Copyright (c) 2025 Nabeel Saleem Alfaradi, Anas Obaidallah Marzouq Alsenani, Khalid Saud Mohammed Aloufi, Mazen Mualla Muslih Almaghthawi, Abdullah Naffaa Nafea Alsaedi, Yasir Awadh Bin Muidh Alsaedi, Majed Ayedh Alahmadi, Mohammed Abdullah Minawer Almehmadi, Sami Hassan H. Alharbi, Hael Khulaif Nafea Alharbi, Muhannad Saud Bakheet Al-Muzaini, Abdulmajid Maneh Matar Al-Ayadhi, Norah Ghalib Alrowaili, Lama Ghwyzy Alraddadi
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