title: Portal hypertensive biliopathy: A single center experience and literature review.
abstract: Portal hypertensive biliopathy (PHB) is characterized by anatomical and functional abnormalities of the intrahepatic, extrahepatic and pancreatic ducts, in patients with portal hypertension associated to extrahepatic portal vein obstruction and less frequently to cirrhosis. These morphological changes, consisting in dilatation and stenosis of the biliary tree, are due to extensive venous collaterals occurring in an attempt to decompress the portal venous blockage. It is usually asymptomatic until it progresses to more advanced stages with cholestasis, jaundice, biliary sludge, gallstones, cholangitis and finally biliary cirrhosis. Imaging modalities of the biliary tree such as Doppler ultrasound, computed tomography, magnetic resonance cholangiopancreatography and endoscopic retrograde cholangiopancreatography are essential to establish the diagnosis and the need of therapeutical interventions. Once the diagnosis is established, treatment with ursodesoxycholic acid seems to be beneficial. Decompression of the biliary tree to dilate, remove stones or implant biliary prosthesis by endoscopic or surgical procedures (hepato-yeyunostomy) usually resolves the cholestatic picture and prevents septic complications. The ideal treatment is the decompression of the portal system, with transjugular intrahepatic porto-systemic shunt or a surgical porto-systemic shunt. Unfortunately, few patients will be candidates for these procedures due to the extension of the thrombotic process. The purpose of this paper is to report the first 3 cases of PHB seen in a Colombian center and to review the literature.
authors.affiliation: Vanessa Suárez, Luisa Fernanda Santos, Adriana Varón, Rafael Claudino Botero, Gastroenterology and Hepatology Service, Department of Internal Medicine, Fundación Cardioinfantil, Bogotá 110131, Colombia.
authors.forename: Vanessa
authors.initials: V
authors.lastname: Suárez
authors.forename: Andrés
authors.initials: A
authors.lastname: Puerta
authors.forename: Luisa Fernanda
authors.initials: LF
authors.lastname: Santos
authors.forename: Juan Manuel
authors.initials: JM
authors.lastname: Pérez
authors.forename: Adriana
authors.initials: A
authors.lastname: Varón
authors.forename: Rafael Claudino
authors.initials: RC
authors.lastname: Botero
keywords: Banti’s syndrome; Bile duct diseases; Biliary obstruction; Cholestasis in children; Interventional endoscopy; Portal vein obstruction
references.citation: J Gastroenterol Hepatol. 2001 Oct;16(10):1086-92
references.pmid: 11686833
references.citation: J Clin Gastroenterol. 2008 Aug;42(7):835-8
references.pmid: 18469722
references.citation: Abdom Imaging. 2012 Feb;37(1):83-90
references.pmid: 21681494
references.citation: Gastrointest Endosc. 1996 Mar;43(3):250-2
references.pmid: 8857145
references.citation: Radiographics. 2002 Sep-Oct;22(5):1053-61
references.pmid: 12235335
references.citation: Br J Surg. 1961 Mar;48:489-98
references.pmid: 13745435
references.citation: Gastrointest Endosc. 1999 Nov;50(5):646-52
references.pmid: 10536320
references.citation: Rev Gastroenterol Mex. 2004 Jan-Mar;69(1):37-41
references.pmid: 15193062
references.citation: Br J Surg. 1965 Feb;52:129-39
references.pmid: 14255983
references.citation: AJR Am J Roentgenol. 2007 Apr;188(4):W341-7
references.pmid: 17377002
references.citation: Gut. 1992 Feb;33(2):272-6
references.pmid: 1541425
references.citation: Hepatology. 2003 Jun;37(6):1302-8
references.pmid: 12774008
references.citation: Dig Liver Dis. 2002 Aug;34(8):587-91
references.pmid: 12502216
references.citation: Eur Radiol. 2009 Nov;19(11):2608-13
references.pmid: 19471939
references.citation: Ann Surg. 2007 Jul;246(1):97-104
references.pmid: 17592297
references.citation: Radiology. 2011 Jan;258(1):146-53
references.pmid: 21045178
references.citation: Transplantation. 2004 Jan 27;77(2):326-7
references.pmid: 14743009
references.citation: Br J Surg. 1983 Apr;70(4):209-11
references.pmid: 6600954
references.citation: AJR Am J Roentgenol. 1994 Mar;162(3):643-5
references.pmid: 8109513
references.citation: Liver Int. 2006 Jun;26(5):512-9
references.pmid: 16761994
references.citation: Gut. 2007 Jul;56(7):1001-8
references.pmid: 17170017
references.citation: Semin Liver Dis. 2002 Feb;22(1):43-58
references.pmid: 11928078
references.citation: Clin Imaging. 2006 May-Jun;30(3):190-4
references.pmid: 16632155
references.citation: Hepatology. 1993 Apr;17(4):586-92
references.pmid: 8477963
references.citation: J Med Imaging Radiat Oncol. 2008 Feb;52(1):4-9
references.pmid: 18373819
references.citation: Endoscopy. 2000 Jul;32(7):520-4
references.pmid: 10917183
references.citation: Eur J Gastroenterol Hepatol. 2009 Feb;21(2):206-13
references.pmid: 19212209
references.citation: Br J Surg. 1965 Aug;52:636-7
references.pmid: 14327079
references.citation: Indian J Med Res. 1984 Mar;79:392-403
references.pmid: 6746055
references.citation: Eur J Radiol. 2009 Jul;71(1):129-34
references.pmid: 18448295
references.citation: Q J Med. 1979 Oct;48(192):627-39
references.pmid: 538223
references.citation: Indian J Med Res. 1968 Nov;56(11):1643-50
references.pmid: 5752198
references.citation: Tunis Med. 2006 May;84(5):291-5
references.pmid: 16915779
references.citation: Hepatology. 2006 Nov;44(5):1063-74
references.pmid: 17058222
references.citation: AIDS Patient Care STDS. 2008 Oct;22(10):771-8
references.pmid: 18783326
references.citation: Gastrointest Endosc. 1999 Mar;49(3 Pt 1):344-8
references.pmid: 10049418
references.citation: Am J Gastroenterol. 1992 Dec;87(12):1801-6
references.pmid: 1449145
references.citation: Jpn J Radiol. 2010 Dec;28(10):754-8
references.pmid: 21191741
references.citation: Ann Hepatol. 2005 Oct-Dec;4(4):286-8
references.pmid: 16432497
references.citation: J Pediatr (Rio J). 2006 May-Jun;82(3):171-8
references.pmid: 16773174
references.citation: Hepatology. 1993 May;17(5):807-13
references.pmid: 8491448
references.citation: HPB (Oxford). 2011 Jan;13(1):33-9
references.pmid: 21159101
references.citation: AJR Am J Roentgenol. 1995 Nov;165(5):1151-5
references.pmid: 7572494