ASGE Annual GI Advanced Practice Provider Course (Virtual) (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

Meta Tag

Concept Chronic Pancreatitis

Concept Biliary Stricture

Concept Biliary Obstruction

Concept Indeterminate Biliary Stricture

Concept Obstructive Jaundice

Keywords

distal common bile duct stricture

chronic pancreatitis

obstructive jaundice

ERCP brush cytology and stenting

pancreatic head cancer vs cholangiocarcinoma

cholangioscopy and EUS-guided biopsy

Chronic Pancreatitis

Biliary Stricture

Biliary Obstruction

Indeterminate Biliary Stricture

Obstructive Jaundice