Therapeutic approaches for portal biliopathy: A systematic review

World J Gastroenterol. 2016 Dec 7;22(45):9909-9920. doi: 10.3748/wjg.v22.i45.9909.

Abstract

Portal biliopathy (PB) is defined as the presence of biliary abnormalities in patients with non-cirrhotic/non-neoplastic extrahepatic portal vein obstruction (EHPVO) and portal cavernoma (PC). The pathogenesis of PB is due to ab extrinseco compression of bile ducts by PC and/or to ischemic damage secondary to an altered biliary vascularization in EHPVO and PC. Although asymptomatic biliary abnormalities can be frequently seen by magnetic resonance cholangiopancreatography in patients with PC (77%-100%), only a part of these (5%-38%) are symptomatic. Clinical presentation includes jaundice, cholangitis, cholecystitis, abdominal pain, and cholelithiasis. In this subset of patients is required a specific treatment. Different therapeutic approaches aimed to diminish portal hypertension and treat biliary strictures are available. In order to decompress PC, surgical porto-systemic shunt or transjugular intrahepatic porto-systemic shunt can be performed, and treatment on the biliary stenosis includes endoscopic (Endoscopic retrograde cholangiopancreatography with endoscopic sphincterotomy, balloon dilation, stone extraction, stent placement) and surgical (bilioenteric anastomosis, cholecystectomy) approaches. Definitive treatment of PB often requires multiple and combined interventions both on vascular and biliary system. Liver transplantation can be considered in patients with secondary biliary cirrhosis, recurrent cholangitis or unsuccessful control of portal hypertension.

Keywords: Endoscopic retrograde cholangiopancreatography; Magnetic resonance cholangiopancreatography; Portal biliopathy; Portal cavernoma; Porto-systemic shunt.

Publication types

  • Review
  • Systematic Review

MeSH terms

  • Abdominal Pain / etiology
  • Bile Duct Diseases / etiology
  • Bile Duct Diseases / therapy*
  • Cholangiopancreatography, Endoscopic Retrograde
  • Cholangiopancreatography, Magnetic Resonance
  • Cholangitis / etiology
  • Cholecystitis / etiology
  • Cholelithiasis / etiology
  • Constriction, Pathologic
  • Humans
  • Hypertension, Portal / complications
  • Hypertension, Portal / therapy*
  • Jaundice, Obstructive / etiology
  • Portal Vein / abnormalities
  • Portasystemic Shunt, Surgical
  • Portasystemic Shunt, Transjugular Intrahepatic

Supplementary concepts

  • Portal Vein, Cavernous Transformation Of