Nonoperative dilatation, performed either endoscopically or percutaneously, can be successfully employed in which of the following etiologies of bile duct strictures?

a.Postoperative bile duct strictures following a hepaticojejunostomy used for reconstruction during a Whipple procedure

c.Primary sclerosing cholangitis

Nonoperative management of bile duct strictures is an available option at most institutions, however, it has some technical limitations due to the anatomic situation. In the so-called "classic laparoscopic bile duct injury" however, complete bile duct transection and discontinuity of the biliary tree eliminates the possibility of nonoperative management. Percutaneous dilatation of biliary-enteric anastomosis has been shown in a number of series to have a success rate approaching that of surgical reconstruction. Although limited experience with either percutaneous or endoscopic dilatation in primary sclerosing cholangitis has been reported, this alternative may provide at least temporary improvement in symptoms and radiologic appearance. Oriental cholangiohepatitis is an unusual infection of the biliary tree frequently associated with Clonorchis sinensis and other parasites. Cholangiography will demonstrate multiple strictures of both the intrahepatic and extrahepatic biliary tree with bile ducts filled with sludge and stones. Surgical management consisting of cholecystectomy and improving biliary drainage with either a Roux-en-Y choledochojejunostomy or choledochoduodenostomy is necessary in almost all patients. Access to the biliary tree for postoperative management of intrahepatic stones or sludge should be maintained, however, with transhepatic biliary stents.