Ep. 567 How to Manage Biliary Strictures with Dr. Premal Trivedi

BackTable Vascular & Interventional

What piques your clinical suspicion for biliary structure? And when is interventional endoscopy the preferred approach? Fine tune your diagnostic and treatment algorithm with Dr. Premal Trivedi from the University of Colorado and host Dr. Christopher Beck as they go in-depth on the management of biliary strictures.
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SYNPOSIS
The doctors first break down the signs and clinical picture that alert them to a possible biliary stricture. Dr. Trivedi then explains the steps of his workup and preferred imaging, and also describes his threshold to pursue percutaneous transhepatic cholangiography (PTC), especially in diffuse conditions like primary sclerosing cholangitis. Dr. Trivedi also walks through his procedural steps for PTC and drain placement, covering his best practices and typical intraoperative decision making.
Dr. Trivedi then explains the role of angioplasty over the course of longitudinal treatment, balloon choice, and his upper limit of catheter upsizing. The doctors also delve into the role of interventional endoscopy and tackling complications such as bleeding and tube leakage. The conversation offers valuable insights for trainees and practitioners alike, and highlights future advancements in biliary interventions.
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TIMESTAMPS
00:00 - Introduction
06:19 - Approach to Biliary Strictures
08:10 - Workup and Imaging for Biliary Strictures
20:41 - Accessing the Biliary System
27:14 - Crossing the Obstruction: Next Steps
33:22 - Endoscopic Evaluation and Its Role
47:14 - Complications and Pain Management
53:40 - Future of Biliary Management
54:55 - Conclusion and Final Thoughts