Cholangiopathy associated with portal hypertension: diagnostic evaluation and clinical implications

• Published in: Gastrointestinal endoscopy Vol. 49; no. 3; pp. 344 - 348
• Main Authors: Malkan, Geeta H., Bhatia, Shobna J., Bashir, Khalid, Khemani, Raju, Abraham, Philip, Gandhi, Malan S., Radhakrishnan, Ravikumar
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.03.1999; Elsevier
• Subjects: Adult; Alkaline Phosphatase - blood; Bile Duct Diseases - diagnosis; Bile Duct Diseases - diagnostic imaging; Bile Duct Diseases - etiology; Bilirubin - blood; Biological and medical sciences; Cholangiography; Common Bile Duct - diagnostic imaging; Digestive system. Abdomen; Dilatation, Pathologic; Endoscopy; Female; Hepatic Duct, Common - diagnostic imaging; Humans; Hypertension, Portal - complications; Investigative techniques, diagnostic techniques (general aspects); Male; Medical sciences; Radionuclide Imaging; Ultrasonography; Radionuclide study; Sonography; Performance evaluation; Human; Biliary tract; Evaluation; Modification; Portal circulation disease; Radiodiagnosis; Cholangiography; Retrograde; Cardiovascular disease; Hepatic disease; Scintigraphy; Biliary tract disease; Vascular disease; Etiology; Echography; Portal hypertension; Digestive diseases; Medical imagery; Diagnosis
• ISSN: 0016-5107; 1097-6779
• DOI: 10.1016/S0016-5107(99)70011-8

Background: There are few studies of biliary changes due to portal hypertension. We ascertained the incidence of such changes on endoscopic retrograde cholangiography and determined the reliability of biochemistry, ultrasonography (US) and hepatobiliary radionuclide scan in detecting this type of cholangiopathy. Methods: Forty-two patients with portal hypertension were studied. Results: Cholangiopathy was detected by cholangiography in 17 of 20 patients with extrahepatic portal venous obstruction. Abnormalities (mainly strictures and caliber irregularity) were seen in the common bile duct (5) and common hepatic duct (7) and in the right (8) and left (11) hepatic ducts (mainly dilatation). One of 11 patients with noncirrhotic portal fibrosis had a dilated right hepatic duct. Three of 11 patients with cirrhosis had pruned intrahepatic ducts. Eight patients with portal venous obstruction had elevated alkaline phosphatase levels; two had elevated bilirubin levels. US detected gallbladder varices (11) and choledochal varices (9) in patients with extrahepatic portal venous obstruction. Biliary abnormalities were detected on hepatobiliary scintigraphy in 16 of 17 patients. Conclusions: Cholangiopathy associated with portal hypertension occurs exclusively in patients with extrahepatic portal venous obstruction. It rarely leads to functional obstruction; jaundice does not occur in the absence of functional blockage. Elevated alkaline phosphatase level (after excluding bile duct calculi), presence of gallbladder varices on US, and abnormal radionuclide scans are reliable in detecting these lesions. (Gastrointest Endosc 1999;49:344-8.)