Portal biliopathy as a complication of extrahepatic portal hypertension: Etiology, presentation and management

• Published in: Journal of visceral surgery Vol. 152; no. 3; pp. 161 - 166
• Main Authors: Le Roy, B, Gelli, M, Serji, B, Memeo, R, Vibert, E
• Format: Journal Article
• Language: English
• Published: France 01.06.2015
• Subjects: Bile Duct Diseases - diagnosis; Bile Duct Diseases - etiology; Bile Duct Diseases - therapy; Cholangiopancreatography, Endoscopic Retrograde; Cholangiopancreatography, Magnetic Resonance; Drainage - instrumentation; Drainage - methods; Humans; Hypertension, Portal - complications; Portasystemic Shunt, Surgical; Sphincterotomy, Endoscopic; Stents; Surgery; Tomography, X-Ray Computed; Biliary stricture; Extrahepatic portal vein obstruction; Portal hypertensive biliopathy; Portal hypertension; Portal biliopathy; Cholangiopathy; Pseudocholangiocarcinoma
• ISSN: 1878-7886; 1878-7886
• DOI: 10.1016/j.jviscsurg.2015.04.003

Summary Portal biliopathy (PB) refers to the biliary abnormalities of the biliary ducts observed in patients with extrahepatic portal hypertension. Although majority of patients are asymptomatic, approximately 20% of these patients present with biliary symptoms (pain, pruritus, jaundice, cholangitis). The pathogenesis of PB is uncertain but compression by dilated veins into or around common bile duct may play the main role. CT-scan, MR cholangiopancreatography with MR portography should be the initial investigations in the evaluation of PB. Treatment is limited to symptomatic cases and is dictated by clinical manifestations and complications of the disease. Treatment of PB could be done by endoscopy (sphincterotomy, stone extraction or biliary stenting of the common bile duct) or surgery (definitive decompression by porto-systemic shunt followed by bilioenteric anastomosis, if necessary). This review describes pathogenesis, clinical features, investigation and management of portal biliopathy.