ASGE Annual GI Advanced Practice Provider Course (On-demand) (Day One) | March 2026-Radiology Studies Case 2- Biliary Stricture

Video Transcription

Video Summary

A 62-year-old woman presents with two months of unintentional weight loss and new jaundice. CT abdomen shows a distal common bile duct (CBD) stricture with upstream biliary dilation plus findings of chronic pancreatitis: marked pancreatic atrophy, pancreatic duct dilation, and intraductal/parenchymal calcifications. Given her age, symptoms, and chronic pancreatitis (a pancreatic cancer risk factor), the main concern is malignancy (pancreatic head cancer or cholangiocarcinoma) versus benign inflammatory stricture.<br /><br />ERCP demonstrates a tight distal CBD stricture; brush cytology is obtained and a plastic stent is placed for temporary drainage. Additional workup shows negative viral serologies and IgG4, mildly elevated CA19-9 (not specific and can rise with cholestasis), and ERCP cytology with atypical cells but no definitive cancer.<br /><br />Because brushings have low sensitivity, next steps include repeat ERCP with cholangioscopy for direct visualization and targeted biopsies, plus possible FISH testing and EUS-guided FNA/FNB of any mass or lymph nodes. Close 3–6 month reassessment and multidisciplinary referral are recommended when suspicion remains high despite inconclusive pathology.

Asset Subtitle

Katelyn Cookson, PA-C, and John A. Martin, MD, FASGE

Keywords

distal common bile duct stricture

obstructive jaundice

chronic pancreatitis

pancreatic head cancer

ERCP brush cytology and biliary stenting

cholangioscopy and EUS-guided biopsy