title: Portal biliopathy as a complication of extrahepatic portal hypertension: etiology, presentation and management.
abstract: 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.
authors.affiliation: Service de chirurgie et oncologie digestive, CHU de Clermont-Ferrand, 63003 Clermont-Ferrand, France; Service de chirurgie hépatobiliaire, centre hépato-bilaire Paul-Brousse, 94800 Villejuif, France.
authors.forename: B
authors.initials: B
authors.lastname: Le Roy
authors.affiliation: Service de chirurgie hépatobiliaire, centre hépato-bilaire Paul-Brousse, 94800 Villejuif, France.
authors.forename: M
authors.initials: M
authors.lastname: Gelli
authors.affiliation: Service de chirurgie hépatobiliaire, centre hépato-bilaire Paul-Brousse, 94800 Villejuif, France; Faculté de médecine, université Mohammed Premier Oujda, Morocco.
authors.forename: B
authors.initials: B
authors.lastname: Serji
authors.affiliation: Service de chirurgie hépatobiliaire, centre hépato-bilaire Paul-Brousse, 94800 Villejuif, France.
authors.forename: R
authors.initials: R
authors.lastname: Memeo
authors.affiliation: Service de chirurgie hépatobiliaire, centre hépato-bilaire Paul-Brousse, 94800 Villejuif, France. Electronic address: eric.vibert.pbr@gmail.com.
authors.forename: E
authors.initials: E
authors.lastname: Vibert
mesh_terms: D001649:Bile Duct Diseases / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D002760:Cholangiopancreatography, Endoscopic Retrograde; D049448:Cholangiopancreatography, Magnetic Resonance; D004322:Drainage / Q000295:instrumentation / Q000379:methods; D006801:Humans; D006975:Hypertension, Portal / Q000150:complications*; D011170:Portasystemic Shunt, Surgical; D016717:Sphincterotomy, Endoscopic; D015607:Stents; D014057:Tomography, X-Ray Computed
keywords: Biliary stricture; Cholangiopathy; Extrahepatic portal vein obstruction; Portal biliopathy; Portal hypertension; Portal hypertensive biliopathy; Pseudocholangiocarcinoma