Endoscopic Management of Biliary Obstruction Caused by Cavernous Transformation of the Portal Vein

Endoscopic Management of Portal Cavernoma Cholangiopathy: Practice, Principles and Strategy

“…The first report of endoscopic extraction of common bile duct stones in PCC 8 was soon followed by other small series 5,[9][10][11][12][13] reporting success without an increase in complications, though some workers reported hemobilia during the procedure. [14][15][16][17] In many centers, endoscopic management has remained confined to establishing drainage of the obstructed biliary system before surgery, in the expectation that either the obstruction would resolve after a period of endoscopic drainage or that portosystemic shunt surgery (PSS), with or without second-stage biliary surgery, would provide definitive management.…”

“…Eleven series published between 1992 and 2011 9,10,12,13,[18][19][20][21][22][23] have reported a mean frequency of 26.3% (16-85%) for biliary calculi among a total of 331 patients, including 143 with symptomatic PCC. Prevalence of both, gallbladder (mean 13.6%, range 0-69%) as well as biliary ductal calculi (mean 17.8%, range 0-77%), is increased and prevalence is much higher in symptomatic PCC, being 60.8% overall in 143 symptomatic patients (35.1% for gallstones, 41.2% for choledocholithiasis).…”

“…Since the first report of biliary stenting for choledochal stenosis in 1993, 6 endoscopic management of symptomatic PCC has been reported in at least 87 patients in 17 case series, 6,[8][9][10][11][12][13]22,[24][25][26][27][28][29][30][31][32] nine of which involved fewer than 4 patients and the largest included 20 patients (Table 2). Results of endoscopic management for biliary stenoses are summarized below.…”

“…From Turkey, Sezgin et al 12 reported endoscopic management of 'severe' strictures in 10 patients with Asymptomatic 18 months (3-90) after stent removal-12; deaths-2; lost to FU-6 ES, endoscopic sphincterotomy; BD, balloon dilatation; CBDS, common bile duct stone; ENBD, endoscopic nasobiliary drainage; FU, follow-up; GS, gallstones; NA, not available; PCC, portal cavernoma cholangiopathy; PSS, portosystemic shunt; CBD, common bile duct; CHD, common hepatic duct; UDCA, ursodeoxycholic acid.…”

“…[8][9][10][11][12][13] None of the series have reported excessive bleeding during ES, suggesting that it is safe in patients with PCC with no more risk than in patients without PCC. Bhatia et al 8 reported uneventful ES and stone extraction in 3 patients with symptomatic PCC and choledocholithiasis.…”