title: Chronic pancreatitis with benign biliary obstruction: management issues.
abstract: BACKGROUND
  Benign biliary obstruction (BBO) is an important complication in patients with advanced chronic pancreatitis (CP). Its presentation varies from an incidental finding to overt jaundice. Thus it presents certain management issues. The present study was therefore performed to analyze the clinical presentation and management of biliary obstruction in patients with CP.
  
  
  METHODS
  Retrospective analysis was performed from a prospectively collected database of 155 CP patients managed at our institute from October 2003 to June 2012.
  
  
  RESULTS
  Among 43 (28 %) CP patients with biliary obstruction, 3 patients had evidence of malignancy on follow-up examination and were excluded from the final analysis. The various presentations include chronic nonprogressive elevation of serum alkaline phosphatase (SAP) (n = 15), a progressive increase in SAP with episodes of jaundice (n = 17), and persistent jaundice (n = 8). Of 15 patients with chronic nonprogressive elevation of SAP, 5 were managed conservatively, and the remaining 10 underwent only a pancreatic drainage procedure. During a median follow-up of 41 months (range 11-90 months), none of the 15 patients developed complications related to biliary obstruction. All patients with progressive increase in SAP levels and persistent jaundice underwent the biliary drainage procedure [choledochojejunostomy (CDJ, n = 20) and choledochoduodenostomy (CDD, n = 3)]. During a median follow-up of 30 months (range 10-89 months), two patients died of unrelated causes and two patients had an asymptomatic elevation of SAP.
  
  
  CONCLUSIONS
  BBO is common in patients with CP; however, biliary drainage is not indicated for chronic nonprogressive elevation of SAP. In patients with a progressive increase in SAP or persistent jaundice, both CDJ and CDD provide effective biliary drainage.
authors.affiliation: Department of Gastrointestinal Surgery, GB Pant Hospital and Maulana Azad Medical College, Room No. 218, 2nd Floor, Academic Block, 1, Jawaharlal Nehru Marg, New Delhi, 110002, India, sundeepsaluja@yahoo.co.in.
authors.forename: Sundeep Singh
authors.initials: SS
authors.lastname: Saluja
authors.forename: Raja
authors.initials: R
authors.lastname: Kalayarasan
authors.forename: Pramod Kumar
authors.initials: PK
authors.lastname: Mishra
authors.forename: Siddarth
authors.initials: S
authors.lastname: Srivastava
authors.forename: Sandip
authors.initials: S
authors.lastname: Chandrasekar
authors.forename: Satyajit
authors.initials: S
authors.lastname: Godhi
mesh_terms: D000328:Adult; D000437:Alcoholism / Q000150:complications; D000469:Alkaline Phosphatase / Q000097:blood; D002768:Choledochostomy; D002779:Cholestasis / Q000097:blood / Q000209:etiology* / Q000628:therapy*; D004322:Drainage; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007565:Jaundice / Q000209:etiology; D008297:Male; D008875:Middle Aged; D050500:Pancreatitis, Chronic / Q000097:blood / Q000150:complications*; D012189:Retrospective Studies; D055815:Young Adult
chemical_list: D000469:Alkaline Phosphatase