Etiology of Common Bile Duct Strictures in Patients Presenting With Obstructive Jaundice at a Tertiary Care Military Hospital
DOI:
https://doi.org/10.51253/pafmj.v76i6.13258Keywords:
Biliary Strictures, Stricture Etiology, Endoscopic Management, CholangiocarcinomaAbstract
Objective: To assess common bile duct stricture etiology and its association with patient age, gender, and stricture location in patients presenting with obstructive jaundice.
Study Design: Cross-sectional analytical study
Place and Duration of Study: Pak Emirates Military Hospital, Rawalpindi, Pakistan, from Feb 24 to Jan 25.
Methodology: Patients with obstructive jaundice (n=96) and confirmed CBD strictures were included. Strictures were classified by location (proximal/mid/distal) and etiology (malignant/benign) using ultrasonography, CT, and ERCP. Inter-rater reliability was confirmed (κ=0.85). Data were analyzed using SPSS v27, and the Pearson chi-square test was used for associations (p<0.05).
Results: The mean age of patients was 55.28 ± 8.96 years, with the majority being male (59.4%). Distal strictures were most prevalent (56.3%), followed by proximal and general strictures (18.8% each), and mid-CBD strictures were the least common (6.3%). Malignancy was the leading cause, and specifically, cholangiocarcinoma was present in 31.3% of 62.6% of malignant cases. There were strong associations between stricture location and etiology (p<0.001), and age and stricture etiology (p<0.001).
Conclusions: The study found that malignant etiologies dominate CBD strictures, particularly in distal locations and older patients. Hence, early malignancy screening must be done for distal strictures, and age-specific diagnostic approaches must be designed for better health outcomes. Multicenter studies should be done to further validate the findings in diverse populations.
Downloads
References
1. Asrani SK, Devarbhavi H, Eaton J, Kamath PS. Burden of liver diseases in the world. J Hepatol 2019; 70(1): 151-171.
https://doi.org/10.1016/j.jhep.2018.09.014
2. Abbas MW, Shamshad T, Ashraf MA, Javaid R. Jaundice: a basic review. Int J Res Med Sci 2016; 4(5): 1313-1319.
https://doi.org/10.18203/2320-6012.ijrms20161196
3. Diala UM, Usman F, Appiah D, Hassan L, Ogundele T, Abdullahi F, et al. Global prevalence of severe neonatal jaundice among hospital admissions: a systematic review and meta-analysis. J Clin Med 2023; 12(11): 3738.
https://doi.org/10.3390/jcm12113738
4. Ullah Z, Hidayat R, Riaz U, Khan H, Naseer A, Asad SJ. Frequency of common bile duct strictures in patients presenting with obstructive jaundice in Ayub Teaching Hospital. Int J Health Sci 2022; 6(S10): 1567-1573.
https://doi.org/10.53730/ijhs.v6nS10.14098
5. Vagholkar KJ. Obstructive jaundice: understanding the pathophysiology. Int J Surg Med. 2020; 6(4): 26-31.
https://doi.org/10.5455/ijsm.2020-07-061-jaundice
6. Rodrigues T, Boike JR. Biliary strictures: etiologies and medical management. Semin Intervent Radiol 2021; 38(3): 255-262.
https://doi.org/10.1055/s-0041-1731086
7. Kapoor BS, Mauri G, Lorenz JM. Management of biliary strictures: state-of-the-art review. Radiology 2018; 289(3): 590-603. https://doi.org/10.1148/radiol.2018172424
8. Hassan Z, Gadour E. Percutaneous transhepatic cholangiography vs endoscopic ultrasound-guided biliary drainage: a systematic review. World J Gastroenterol 2022; 28(27): 3514-3523.
https://doi.org/10.3748/wjg.v28.i27.3514
9. De Angelis CG, Dall'Amico E, Staiano MT, Gesualdo M, Gaia S, Bruno M, et al. The endoscopic retrograde cholangiopancreatography and endoscopic ultrasound connection: unity is strength. Diagnostics 2023; 13(20): 3276.
https://doi.org/10.3390/diagnostics13203265
10. Dumonceau JM, Delhaye M, Charette N, Farina A. Challenging biliary strictures: pathophysiological features, differential diagnosis, diagnostic algorithms. Ther Adv Gastrointest Endosc 2020; 13: 1756284820927292.
https://doi.org/10.1177/1756284820927292
11. Pratyusha C, Ajmir B, Pasha SA, Reshma G. A cross-sectional study of etiological and clinical profile of surgical jaundice. J Adv Med Pharm Sci 2024; 6(6): 762-765.
https://doi.org/10.47009/jamp.2024.6.6.144
12. Shukla S, Kharat PR, Kumar K. Clinicopathological study on patients presenting with obstructive jaundice. Int Surg J 2018; 5(2): 705-710.
https://doi.org/10.18203/2349-2902.isj20180378
13. Siddique K, Ali Q, Mirza S, Jamil A, Ehsan A, Latif S. Evaluation of the aetiological spectrum of obstructive jaundice. J Ayub Med Coll Abbottabad 2008; 20(4): 62-66.
14. Machado LC, Martins BC, de Lima MS, Geiger S, Lenz L, de Paulo GA, et al. Results of endoscopic treatment of recurrent malignant biliary obstruction. Dig Dis Sci 2024; 69(1): 123-130. https://doi.org/10.1007/s10620-023-08250-3
15. Tariq MA, Malik MK, Khan M, Majoka ZA, Asrar A. Rising mortality of intrahepatic cholangiocarcinoma. Liver Int 2025; 45(1): e16212. https://doi.org/10.1111/liv.16212
16. Dorrell R, Pawa S, Zhou Y, Lalwani N, Pawa R. The diagnostic dilemma of malignant biliary strictures. Diagnostics 2020; 10(5): 337. https://doi.org/10.3390/diagnostics10050337
17. Khan K, Shahzadi A, Gul M, Naz N, Faisal M, Faryal S. Complications associated with metal ceramic prosthesis in fixed partial denture used in Peshawar. J Health Rehabil Res 2024; 4(1): 967-972.
https://doi.org/10.61919/jhrr.v4i1.524
18. Kordeni K, Vezakis A, Voulgaris T, Sotirianakou A, Politi E, Gazouli M. Methods improving endoscopic retrograde cholangiopancreatography brush cytology in malignant biliary strictures. World J Gastroenterol 2026; 32(21): 117828 https://doi.org/10.3748/wjg.v32.i21.117828
19. Simoes PK, Schattner MA, Gerdes H, Shah PM, Kurtz RC. Endoscopic stenting for malignant biliary obstruction. Endosc Int Open. 2022; 10(4): E429-E433.
https://doi.org/10.1055/a-1783-9310
20. Cocca S, Casoni Pattacini G, Grova A, Esposito S, et al. Biliary drainage in patients with altered anatomy: Literature review of different endoscopic approaches. World J Gastroenterol 2026; 32(2): 113071
Downloads
Published
License
Copyright (c) 2026 Muhammad Elham Wahid, Malik Nadeem Azam Khan, Ijaz Ahmed, Muhammad Abdul Haseeb Siddiqui; Muhammad Furqan Siddique; Muhammad Shahbaz Shoaib
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
How to Cite
