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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Protocolize Upsizing To 18–22F
- Follow a protocol: start with a 10F drain, brush suspicious lesions, and upsize by ~4F every two weeks.
- Target 18–22F (18F commonly sufficient) within about 4–6 weeks for benign strictures.
Balloon Carefully And Inflate Longer
- Reserve aggressive ballooning for tight or final upsizings and generally use high-pressure POBA for biliary angioplasty.
- Use 6–10mm balloons depending on duct location and perform longer inflations (about 3 minutes).
Endoscopy Reveals Hidden Causes
- Percutaneous endoscopy often reveals causes that fluoroscopy misses, like stones or sutures mimicking strictures.
- Endoscopy empowers targeted biopsies and changes diagnosis thresholds for 'benign' strictures.