Bile Duct Diseases: Cholangitis, Gallstones & Strictures

The multidisciplinary team of physicians at Froedtert & the Medical College of Wisconsin have significant training and experience in treating diseases of the bile ducts, including:

Primary Biliary Cholangitis (PBC)  

Primary biliary cholangitis (PBC) is a chronic autoimmune liver disease that gradually damages the small bile ducts within the liver, leading to bile buildup, inflammation, and eventual scarring (cirrhosis). This condition most commonly affects women over the age of 40 and often progresses slowly. Early symptoms may include persistent fatigue, itchy skin, and dry eyes or mouth, while more advanced stages can cause jaundice, abdominal discomfort, and swelling in the legs or abdomen. Although there is no cure, treatments such as ursodeoxycholic acid (UDCA) and obeticholic acid can help slow disease progression and improve liver function. Additional therapies may address symptoms like itching or vitamin deficiencies, and in severe cases, a liver transplant may be necessary to restore health.

Primary Sclerosing Cholangitis (PSC)

Primary Sclerosing Cholangitis (PSC) is a rare, progressive liver disease that causes chronic inflammation and scarring of the bile ducts, which impairs the flow of bile and leads to liver damage over time. While many individuals may be asymptomatic in the early stages, common symptoms include fatigue, itching, abdominal pain, jaundice (yellowing of the skin and eyes), and unintended weight loss. As PSC advances, complications such as infections, vitamin deficiencies, and even liver failure may occur. Although there is no cure, treatment focuses on managing symptoms and complications—this may include medications for itching, antibiotics for infections, vitamin supplements, and procedures to relieve bile duct blockages. In severe cases, a liver transplant may be necessary to restore liver function.

Gallstones in the Bile Duct (Choledocholithiasis)

A gallstone may form in the bile duct, causing an obstruction in the duct. Complete obstruction of bile duct can cause cholangitis or can lead to an obstruction of the pancreatic duct, which may cause pancreatitis.

Bile Duct Tumors 

Many people with bile duct tumors have jaundice due to the tumor obstructing the bile ducts. Tumors in the bile duct can cause obstruction with biliary stasis (an accumulation of bile), liver dysfunction, malnutrition, bleeding, kidney dysfunction, and cholangitis. Treatment depends on the tumor site, and the type and extent of the tumor. Surgery offers the only potential cure for this type of tumor.

Strictures of the Bile Duct

A stricture is a narrowing of the bile duct, which prevents bile from draining into the intestine. The bile backs up into the liver, causing obstructive jaundice. Strictures of the bile duct can be benign or malignant.

Benign Bile Duct Strictures 

Non-cancerous bile duct strictures occur when a bile duct is injured, such as damage to a duct during surgery for gallstones, trauma to the abdomen or disease such as chronic pancreatitis. This may cause serious complications such as cholangitis (an infection in the bile duct), liver abscess or biliary cirrhosis.

Malignant Bile Duct Strictures 

Bile duct strictures are caused by tumors of the bile duct (cholangiocarcinomas), gallbladder or pancreas. A malignant bile duct stricture is an abnormal narrowing of the bile duct caused by cancerous growths. These strictures block bile flow from the liver to the small intestine, leading to jaundice, liver dysfunction, and potential infections.

Bile Duct Injury and Disease Treatments

People with bile duct injury or disease often require complex, multidisciplinary procedures. The liver/pancreas/gallbladder/bile duct team at Froedtert & the Medical College of Wisconsin has the skill and experience to treat a wide variety of procedures.

• Biliary biopsy and brushings — a technique to gather cells and scrapings from a bile duct to provide a biopsy sample. This involves using a catheter with a brush strip on the end. The catheter is inserted into a duct and pulled back and forth to gather cells. The brush allows the collection of enough tissue to provide a biopsy sample without great risk of damaging the duct.
• Choledochoscopy — a minimally invasive procedure to explore the bile duct for suspected stones. A tool called a choledochoscope is used to look for stones. This tool also provides a channel through which instruments can be passed to remove the stones.
• Resection (surgical removal) of the extrahepatic (outside the liver) bile duct with reconstruction to a loop of small bowel for the bile to drain (a procedure that rearranges the drainage system of the liver). This may be a Roux-en-Y hepaticojejunostomy procedure or a choledochojejunostomy procedure, depending on where the bile duct joins the bowel.
• Percutaneous transhepatic cholangiography (PTC) — a radiologist performs this procedure using conscious sedation. This procedure can also be done by a surgeon in the operating room. A thin needle is inserted through the skin (percutaneously) and through the liver (transhepatic) into a bile duct. Dye is then injected into the liver to enable the bile duct system to be seen on X-rays (cholangiography).
• Placement of a T-tube — placement of a tube into the bile duct. Various diagnostic and therapeutic procedures are possible through these tubes (i.e., stone retrieval, cholangiograms, stent placement, etc.).
• Stenting — a stent is a thin, flexible tube inserted into a duct to keep it open. A stent may be placed in the liver to drain bile into the small intestine or a collection bag outside the body. A stent may also be placed in a bile duct to guide surgery, to keep a duct open if a tumor cannot be removed, or to open strictures (narrowing) of the bile duct.