An interventional study of distal cbd stricture and papillary stenosis in patients with opium addict: at a tertiary care hospital

Context: Bile duct stricture (biliary stricture) is an uncommon but challenging clinical condition that requires a co-ordinated multidisciplinary approach involving gastroenterologists, radiologists, and surgical specialists. Most benign distal bile duct strictures results from operative causes, chronic pancreatitis, trauma. Aims: To describe the risk factors and demographic data in patients with symptomatic distal CBD stricture and papillary stenosis associated with significant opium intake. Setting and design: Hospital based prospective study Materials and Methods: The patients were selected from the gastroenterology unit Christian Medical College & Hospital, Ludhiana a tertiary care hospital in Northwest India to whom all subjected to ERCP. Results: From a total of 373 ERCP of which 15 male patients were included who consumed significant amount of opium over a long period and developed clinically CBD stricture with papillary stenosis. Post procedure ALP levels were significantly decreased as compared to pre procedure. The length of the stricture in our study showed a strong correlation with the levels of the ALP. Conclusion: Opium can cause distal CBD stricture and associated papillary stenosis which are multiple pathophysiologic mechanism, however symptomatic CBD stricture need to treat in time to prevent feared complications. In patients presenting with distal CBD stricture a history of opium consumption is vital along with supportive services and counseling to deal with the addiction.