Portal biliopathy.
Portal biliopathy refers to cholangiographic abnormalities which occur in patients with portal cavernoma. These changes occur as a result of pressure on bile ducts from bridging tortuous paracholedochal, epicholedochal and cholecystic veins. Bile duct ischemia may occur due prolonged venous pressure effect or result from insufficient blood supply. In addition, encasement of ducts may occur due fibrotic cavernoma. Majority of patients are asymptomatic. Portal biliopathy is a progressive disease and patients who have long standing disease and more severe bile duct abnormalities present with recurrent episodes of biliary pain, cholangitis and cholestasis. Serum chemistry, ultrasound with color Doppler imaging, magnetic resonance imaging with magnetic resonance cholangiopancreatography and magnetic resonance portovenography are modalities of choice for evaluation of portal biliopathy. Endoscopic retrograde cholangiography being an invasive procedure is indicated for endotherapy only. Management of portal biliopathy is done in a stepwise manner. First, endotherapy is done for dilation of biliary strictures, placement of biliary stents to facilitate drainage and removal of bile duct calculi. Next portal venous pressure is reduced by formation of surgical porto-systemic shunt or transjugular intrahepatic portosystemic shunt. This causes significant resolution of biliary changes. Patients who persist with biliary symptoms and bile duct changes may benefit from surgical biliary drainage procedures (hepaticojejunostomy or choledechoduodenostomy).
Mohammad S Khuroo, Sher-I-Kashmir Institute of Medical Sciences, Srinagar Kashmir 190010, India.
Mohammad S
MS
Khuroo
Mohammad S Khuroo, Sher-I-Kashmir Institute of Medical Sciences, Srinagar Kashmir 190010, India.
Ajaz A
AA
Rather
Mohammad S Khuroo, Sher-I-Kashmir Institute of Medical Sciences, Srinagar Kashmir 190010, India.
Naira S
NS
Khuroo
Mohammad S Khuroo, Sher-I-Kashmir Institute of Medical Sciences, Srinagar Kashmir 190010, India.
Mehnaaz S
MS
Khuroo
D001652:Bile Ducts / Q000473:pathology; D001659:Biliary Tract / Q000473:pathology*; D002758:Cholangiography / Q000009:adverse effects; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000009:adverse effects*; D002761:Cholangitis / Q000150:complications; D002779:Cholestasis / Q000209:etiology / Q000378:metabolism*; D005705:Gallbladder Diseases / Q000150:complications; D006801:Humans; D006975:Hypertension, Portal / Q000175:diagnosis; D007511:Ischemia; D008099:Liver / Q000601:surgery; D017082:Portal Pressure; D011169:Portal Vein / Q000473:pathology* / Q000601:surgery; D011170:Portasystemic Shunt, Surgical; D015607:Stents / Q000009:adverse effects
Bile duct calculi; Bile duct strictures; Biliary disease; Extrahepatic portal venous obstruction; Portal cavernoma
Trop Gastroenterol. 2003 Jul-Sep;24(3):116-9
14978982
ACG Case Rep J. 2013 Oct 08;1(1):44-6
26157818
J Clin Exp Hepatol. 2012 Dec;2(4):338-52
25755456
Gut. 2007 Jul;56(7):1001-8
17170017
Cir Cir. 2014 Nov-Dec;82(6):680-5
25393868
Indian J Gastroenterol. 2009 Jan-Feb;28(1):35-7
19529903
Gastroenterol Rep (Oxf). 2016 Feb;4(1):68-72
25216728
Gastrointest Endosc. 2014 Jun;79(6):1015-9
24713306
Transplantation. 2004 Jan 27;77(2):326-7
14743009
Endosc Ultrasound. 2015 Jan-Mar;4(1):76-7
25789291
J Clin Exp Hepatol. 2014 Feb;4(Suppl 1):S18-26
25755590
Trop Gastroenterol. 2003 Oct-Dec;24(4):165-6
15164525
Gut. 2011 Jun;60(6):853-60
21270119
Gut. 1992 Feb;33(2):272-6
1541425
J Clin Exp Hepatol. 2014 Feb;4(Suppl 1):S67-76
25755598
J Clin Exp Hepatol. 2014 Feb;4(Suppl 1):S62-6
25755597
J Clin Exp Hepatol. 2014 Feb;4(Suppl 1):S27-33
25755592
Eur J Gastroenterol Hepatol. 2009 Feb;21(2):206-13
19212209
Am J Gastroenterol. 1995 Nov;90(11):2015-9
7485013
Br J Surg. 1999 Jan;86(1):138
10027383
J Gastroenterol Hepatol. 2001 Oct;16(10):1086-92
11686833
Eur J Radiol. 2009 Jul;71(1):129-34
18448295
Ann Surg. 2007 Jul;246(1):97-104
17592297
Clin Imaging. 2006 May-Jun;30(3):190-4
16632155
J Clin Exp Hepatol. 2014 Feb;4(Suppl 1):S77-84
25755599
J Minim Access Surg. 2014 Jul;10(3):161-2
25013336
J Clin Exp Hepatol. 2014 Feb;4(Suppl 1):S34-6
25755593
Clin Gastroenterol Hepatol. 2012 Jan;10 (1):A34
21888882
Acta Radiol. 2000 Nov;41(6):612-5
11092484
HPB (Oxford). 2013 Jul;15(7):559
23750497
Gastrointest Endosc. 2010 Apr;71(4):885-6; author reply 886
20363438
Intern Med. 2013;52(10 ):1055-9
23676590
Tunis Med. 2006 May;84(5):291-5
16915779
Gastrointest Endosc. 2014 Dec;80(6):1175
24818548
Br J Surg. 1979 Jun;66(6):379-84
466017
Aliment Pharmacol Ther. 2006 Mar 15;23 (6):767-75
16556179
Endosc Ultrasound. 2015 Jan-Mar;4(1):44-51
25789284
Gastrointest Endosc. 2003 Oct;58(4):602-8
14520303
Exp Clin Transplant. 2011 Apr;9(2):145-9
21453234
Gastrointest Endosc. 2009 Sep;70(3):555-6; discussion 556
19595317
Br J Surg. 1998 Mar;85(3):326-9
9529484
Hepatology. 2003 Jun;37(6):1302-8
12774008
Jpn J Radiol. 2010 Dec;28(10 ):754-8
21191741
Gastrointest Endosc. 2009 Nov;70(5):1041-3
19631938
ANZ J Surg. 2015 Jul-Aug;85(7-8):561-6
24237891
J Visc Surg. 2015 Jun;152(3):161-6
26025414
J Gastroenterol Hepatol. 2005 Oct;20(10):1494-502
16174064
J Clin Exp Hepatol. 2014 Feb;4(Suppl 1):S2-S14
25755591
Gastrointest Endosc. 1999 Mar;49(3 Pt 1):344-8
10049418
Dig Liver Dis. 2002 Aug;34(8):587-91
12502216
J Gastroenterol Hepatol. 2005 Jan;20(1):56-61
15610447
Gastrointest Endosc. 1995 Aug;42(2):178-81
7590059
Gastrointest Endosc. 2010 Dec;72(6):1317-9
20561622
Hepatology. 1993 May;17 (5):807-13
8491448
AJR Am J Roentgenol. 2007 Apr;188(4):W341-7
17377002
Vascular. 2008 Nov-Dec;16(6):356-8
19344595
Gastrointest Endosc. 2009 Jul;70(1):171-3
19409559
Radiology. 2011 Jan;258(1):146-53
21045178
Ann Hepatol. 2005 Oct-Dec;4(4):286-8
16432497
Gastrointest Endosc. 2004 Dec;60(6):1021-4
15605028
Clin Imaging. 2015 Sep-Oct;39(5):841-4
26004045
HPB (Oxford). 2011 Jan;13(1):33-9
21159101
Endoscopy. 1996 Aug;28(6):521
8886642
J Clin Gastroenterol. 2006 May-Jun;40(5):453-4
16721234
Clin Imaging. 2012 Mar-Apr;36(2):126-34
22370133