BackTable Vascular & Interventional Ep. 567 How to Manage Biliary Strictures with Dr. Premal Trivedi
Aug 26, 2025
Join Dr. Premal Trivedi, Chief of IR at the University of Colorado and an expert in interventional radiology, as he dives into the complexities of managing biliary strictures. He discusses key signs that trigger clinical suspicion and the preferred role of interventional endoscopy. You'll hear about his workup process, preferred imaging techniques, and the nuances of percutaneous transhepatic cholangiography. The conversation also highlights innovative treatment strategies and the evolution of training in interventional radiology.
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Start By Confirming It's A Stricture
- Begin every referral by asking whether it truly is a biliary stricture versus general biliary obstruction.
- Use clinical context to judge benign versus malignant likelihood before invasive steps.
Use MRCP For Advanced Mapping
- Order MRCP as your first advanced cross-sectional imaging to map suspected strictures when ultrasound/CT are inconclusive.
- Rely on combined lab, history, and hepatology input in transplant patients before PTC.
Prioritize Endoscopy And Correct Coagulopathy
- Prefer endoscopic treatment when feasible and avoid PTC if uncontrolled ascites or uncorrected coagulopathy exist.
- Ensure INR is acceptable (Primal's threshold ~<1.8) and manage bleeding risk before percutaneous access.