: Secondary biliary cirrhosis (SBC) arises from sustained obstruction of the biliary tract, culminating in progressive cholestatic injury and fibrosis. Despite its clinical significance, literature delineating its etiological spectrum, onset chronology, and biochemical–radiological characteristics remains remarkably scarce. Emerging evidence suggests that timely and appropriate biliary intervention may partially reverse fibrosis. Our aim is to elucidate the prevalence, delineate the relative contribution of benign and malignant causes, determine the temporal evolution from disease onset to cirrhosis, and evaluate post-interventional outcomes

The study was conducted at Gastroenterology Department of a major tertiary referral centre in north-west India. Among all admitted 1950 extrahepatic biliary obstruction (EHBO) patients, patients of SBC were selected. Primary objective of this study is to assess prevalence of SBC in all EHBO patients. Secondary objectives were to assess sociodemographic pattern, clinico-biochemical characteristics, aetiological spectrum, duration of onset of secondary biliary cirrhosis, radiological presentation, severity of cirrhosis and outcomes of biliary decompression

Out of a total of 1,950 individuals enrolled, 149 patients developed SBC & prevalence came out to be 7.6%. Among them, 53.7 % patients were females & 46.3 % were males. 33.6% patients were benign ones while the rest, 66.4% were of malignant aetiologies. Most common aetiology repercussion into SBC is carcinoma gall bladder which accounts for 33.6 % cases. Among benign aetiologies, common bile duct (CBD) stricture is the most common one reported with 23.5 % cases. Median duration for the development of SBC is less for malignant aetiologies which is 2(2-4) months, whereas for benign causes it is 96 (57-123) months with significant p value of <0.001. In all benign aetiologies of SBC, free fluid was present in all patients. The frequency of intervention varied significantly between the two groups with p value 0.01. The decrease in liver stiffness measurements (LSM) over the 12 months period was statistically significant in cholangiocarcinoma, carcinoma head of pancreas, metastatic lymphadenopathy and among all benign aetiologies with p value <0.05.

In summation, SBC exhibited a conspicuous predilection for the female cohort, with malignant aetiologies predominating and demonstrating a truncated latency to overt manifestation. Notably, the institution of biliary drainage engendered a marked attenuation of LSM, corresponding to fibrosis, across both investigative arms, underscoring its potent therapeutic efficacy and capacity to ameliorate disease trajectory.