Determining the Indeterminate in Biliary Strictures Lionel S. D’Souza, MD, Juan Carlos Bucobo, MD PII: S1542-3565(19)31032-8 DOI: Reference: YJCGH 56763 To appear in: Clinical Gastroenterology and Hepatology Accepted Date: 19 SeptemberWe live in an era where there is little room for the unknown and, fortunately, technology has afforded us the ability to minimize uncertainty. Terms such as ‘indeterminate’ strictures, ‘indefinite’ for dysplasia and malignancy of ‘unknown’ primary, cause a great deal of uneasiness and at times distress. Meanwhile, the administrative stressors of medicine have forced physicians to do more and spend less, all in the shortest possible amount of time. The patient with an ‘indeterminate’ biliary stricture is no exception and continues to pose both a diagnostic and therapeutic challenge to treating gastroenterologists, surgeons and oncologists despite recent advances in imaging and diagnostic testing. Valuable time and significant healthcare dollars are expended in obtaining a definitive, timely diagnosis. Retrospective observational studies suggest that up to 25% of indeterminate biliary strictures prove to be benign following high-stakes surgical resections yet the majority of these strictures tend to be malignant, either in surgical specimens or by progression of disease 1,2. Etiologies such as primary sclerosing cholangitis, IgG4-associated sclerosing cholangitis as well as other infectious, inflammatory and iatrogenic causes may have an indolent course; however, the fear of missing or delaying the diagnosis of malignancy is the root of concern. NO ABSTRACT. TEXT CUT AFTER INITIAL LINES. FREE FULL TEXTLeggi l'articolo


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