Question about Common Bile Duct Stricture (Page 2 of 2)

Your mother's story reminds me  a bit of my own (which you can read about on here in more detail if you look at my old messages), just under a year ago I went in to see my doctor thinking I was a ,mostly healthy 42 year old man, who was just getting over a broken back due to a fall a few months earlier, on a routine follow up visit, I mentioned I had been experiencing some itching and he did blood work for liver levels which started the ball rolling.  Ultra-sound found gallstones, referral to a general surgeon then to an MRCP which showed a "blockage" in the common bile duct, so the surgeon sent me to a Gastroenterologist for an ERCP, which found the blockage was really a stricture (scraping biopsy negative, but also told they were unreliable in these cases), on to a specialist Gastroenterologist who did a Spyglass ERCP, biopsy again negative, but visually he reported it looked "highly consistant with CC", places a stint to help things flow so on to the speciality liver surgeons.  I have my fist gallbladder pain a few days before my appointment to consult with the surgeons, local doctor puts me on antibiotics knowing I was scheduled to see a surgeon within a few days, I see the surgeon am told it is an 80% chance of CC even with negative biopsies, he is concerend about the gallbladder infection, schedules me in for surgery (ended up getting a Roux-en-Y hepaticojejunostomy instead of Whipple due to placement of the stricture higher up in the bile duct, similar surgery though), surgeon has a CT scan done, and ends up admitting my to the hospital on the spot, gallbladder is highly infected, erored into the liver, looks like the stint blocked the opening to the gallbladder which was already mostly blocked by gallstones, they put a drain in and have me on IV antibiotics for a week, then home for a week or so to let the infection clear up then back for the big surgery with a drain pouch taped to my side.  I have the big surgery and thankfully it turned out the stricture was benign, the surgeon said it was best to do the surgery anyway as even if benign strictures can turn into CC a lot of the time.  Spent a week in the hospital, then several weeks recovering at home, the surgery was rough, but the real issue was the fatigue afterward, even 6-8 weeks later I barely had the strength to drive myself to the store to run short errands.  Anyway I just had my 6 month follow up, liver lelels look good, but the doctors are telling me it will have to be checked every 6 months from here on out.

Here we are almost another year later and more CT Scans, biopsy, blood work, & EUS performed still not showing any signs of cancer. We just visited the Cancer Doctor last week and he told us that he believes that it is Bile Duct Cancer and from the other visits, recommending the Whipple Procedure again to rule out if it is Cancer.

I was wondering, if there is any other reason the Bile Duct can become blocked without being Cancer? It's just, we have been doing this for almost two years and I would have thought something would have showed up in the tests and nothing. Do we take the risk of the procedure after everything she has done, showing nothing or continue to monitor it with the scans and bloodwork?

Hi Teresa,

To answer your question:

Yes, the bile duct can become blocked by a benign stricture. Unfortunately, the existing diagnostic tests cannot reliably distinguish cancerous and benign strictures. They look almost the same on all tests.

Benign strictures can be caused by:

* Inflammation.

* Surgical trauma from prior surgery in the area, such as gallbladder removal.

This is not a complete list. I recall seeing medical papers that discussed about 5-7 different types of benign strictures. I will post the links if I can find them.