**5. Benign biliary strictures**

Biliary strictures occur during CP in 3–23% of all patients. Peribiliary fibrosis or pressure of the pancreatic pseudocyst (PPC) may play a role in pathophysiology. They can be asymptomatic or present with jaundice, cholangitis, or choledocholithiasis.

Jaundice could be resolved in 20–50% of patients in 1 month spontaneously [38]. However, secondary biliary cirrhosis is frequent (7.3%), and asymptomatic serum alkaline phosphatase and/or bilirubin for longer than 4 weeks predicts the need for endoscopic management [39]. As in all strictures of the hepatobiliary tract, malignancies should be excluded.

Single plastic stents are ineffective for the long-term management of biliary strictures. Multiple side-by-side plastic stents or FCSEMSs are widely used for endoscopic treatment. These stents have been suggested as the primary treatment for benign biliary strictures in the absence of associated lesions (such as inflammatory masses). Moreover, the success of the treatment was evaluated after 12 months or three endoscopic procedures. A single retrospective study comparing surgery and endoscopy reported that endoscopy had lower morbidity (21%, 83%) and success (15%, 66%) in the second year of treatment, which could be related to accepting incomplete resolution as a failure [40]. Uncovered SEMSs were not considered because of their poor long-term results. Multiple side-by-side plastic stents and FCSEMSs have similar success (88%, 90.9%) and morbidity (23.3%, 28.6%) rates [41]. If the stricture does not respond to endoscopic therapy, hepaticojejunostomy remains a valid treatment option.
