Biliary stricture management: European Society of Gastrointestinal Endoscopy (ESGE) Guideline.

Key Takeaways for GI Nurses

• Benign biliary stricture management now favors either multiple plastic stents (MPSs) placed temporarily or, in select patients, a fully covered self-expandable metal stent (FCSEMS)—nurses should anticipate longer procedure times and increased device/accessory needs when multiple plastic stents are planned per ERCP session.
• Patient selection criteria matter clinically: FCSEMS may be offered when strictures are located more than 2 cm from the hepatic confluence, or when patients have documented noncompliance with repeat ERCP scheduling—nursing staff play a key role in tracking follow-up adherence and communicating barriers to the care team.
• For chronic pancreatitis-related strictures, FCSEMS placement is now suggested for a defined 6-12 month duration, meaning nurses coordinating scheduling and pre-procedure teaching should build in structured stent-removal follow-up windows.
• Primary sclerosing cholangitis (PSC) strictures are managed with balloon dilation alone (no stent) per this guidance—nursing teams should ensure procedural setup reflects this simpler approach and that patient education addresses why a stent is not being left in place, especially since stenting may increase adverse events in this population.

Clinical Relevance

This ESGE guideline provides endoscopy nurses with a clearer framework for anticipating procedural setup, equipment needs, and patient teaching based on stricture etiology. Because recommendations differentiate management by cause—postcholecystectomy injury, post-liver-transplant anastomotic strictures, chronic pancreatitis, and PSC—nurses involved in pre-procedure assessment and chart review can better anticipate whether a case will require multiple plastic stent trays, an FCSEMS deployment system, or simple balloon dilation equipment. This foreknowledge supports more efficient room turnover and appropriate staffing for potentially longer, multi-stent ERCP cases.

Patient education and discharge planning are also directly affected. Since MPS strategies often require several sequential ERCPs to achieve stricture resolution, nurses are frequently the primary point of contact reinforcing the importance of returning for scheduled stent exchanges. Conversely, FCSEMS placement—suggested as an alternative for patients who struggle with repeated procedures—reduces the frequency of endoscopic sessions but introduces its own risks, including stent migration, cholangitis, or need for early removal, all of which nursing teams should incorporate into post-procedure instructions and symptom-monitoring education. For chronic pancreatitis patients specifically, discharge teaching should clearly convey the anticipated stent duration (6-12 months) and the necessity of a defined removal appointment, since these stents are not intended for indefinite placement.

From an operational standpoint, this guideline also reinforces the importance of interdisciplinary communication regarding treatment rationale, particularly for PSC patients undergoing dilation-only strategies. Nurses may need to manage patient expectations when no stent is placed after dilation, explaining that this approach reflects current evidence showing no added benefit—and potential harm—from stenting in this population. Additionally, the explicit caution against uncovered SEMS in benign disease is a useful reminder for nurses assisting with device selection verification during procedures, helping prevent inadvertent use of permanent, non-removable stents in conditions where removability is essential.

Bottom Line

For GI nurses, the essential takeaway is that benign biliary stricture treatment is increasingly individualized by cause and stricture location, directly shaping procedural setup, stent selection, and follow-up scheduling—so understanding the etiology-specific pathway (MPS vs. FCSEMS vs. dilation-only) is key to anticipating patient teaching needs, procedural resource planning, and ensuring appropriate, timely stent removal.