Role of ERCP for the diagnosis of indeterminate biliary stenosis and the treatment of benign (non-neoplastic) biliary stenosis in adults

In the first part of this thesis, the diagnostic role of Endoscopic Retrograde Cholangiopancreatography (ERCP) in suspected malignant biliary stenosis) is reported. Sophisticated techniques have been proposed to optimize the diagnostic accuracy of this procedure. We report the major contribution of a simple and safe procedure: bile cytological analysis performed during ERCP in combination with cytological brushing illustrated by our experience detailed in 2 publications. The role of ERCP with a single operator cholangioscopy (SOC) for the diagnosis of indeterminate biliary stenosis and its significant impact on patient management is reported in a third publication. In the second part, the role of therapeutic ERCP is detailed for the treatment of benign biliary stenosis. The role of cSEMS for biliary post-operative stenosis is reported along with our local experience. In addition, ERCP stenting is suggested as an alternative therapy for the particular case of biliary stenosis of alveolar echinococcosis. These two aspects are illustrated by publications. ERCP remains essential in 2021 for the diagnosis of indeterminate biliary stenosis and the treatment of benign biliary stenosis. In the concluding chapter, we focus on current challenges for teaching ERCP to trainees and standards of performance for practitioners after initial training for this demanding endoscopic technique