Biliary Obstruction Differential Diagnoses

Updated: Nov 27, 2016
  • Author: Jennifer Lynn Bonheur, MD; Chief Editor: Vinay Kumar Kapoor, MBBS, MS, FRCS, FAMS  more...
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Diagnostic ConsiderationsImportant considerationsSpecial concernsOther problems to consider

Once a diagnosis has been made, the physician has the responsibility to ensure that the patient responds to the appropriate therapy. If no response occurs, reevaluate the patient to make sure other causes of biliary obstruction are not missed.

In patients who have undergone gastrointestinal bypass surgery (eg, gastrojejunostomy, hepatojejunostomy, biliopancreatic diversion) the normal anatomy is surgically altered precluding endoscopic retrograde cholangiopancreatography (ERCP) using standard equipment. In such cases, double balloon enteroscopy (DBE) has been studied as a potential way to overcome endoscopic limitations and enable ERCP in patients with biliary obstruction. [5, 6] DBE is an advanced endoscopic technique which was developed to endoscopically evaluate the small bowel. It requires specialized training in order to perform routinely and, in particular, when it is utilized for ERCP.

Consider the following in patients with suspected biliary obstruction:

  • Drugs/toxins
  • Infection (eg, parasitic, AIDS-associated, bacterial)
  • Parenteral nutrition

Differential Diagnoses