Liver histopathology in chronic common bile duct stenosis due to chronic alcoholic pancreatitis

Abstract

The liver histopathology in 40 liver biopsies from 24 patients with verified chronic common bile duct stenosis due to chronic alcoholic pancreatitis has been reviewed code‐blinded. This represents an 8% prevalence of this complication in approximately 300 patients with alcoholic pancreatitis screened biochemically for alkaline phosphatase >two‐fold for >1 month. The majority were anicteric with no symptoms other than from acute exacerbations of chronic pancreatitis. Biliary obstructive liver histopathology of varying severity was diagnosed in 19 patients (79%), seven of whom (29%) had secondary biliary cirrhosis. In 3 of these 7 cases, progression to biliary cirrhosis was documented with sequential biopsies. The remainder demonstrated this histologic picture when first diagnosed, supporting the insidious nature of this process. Stromal edema of the portal tracts, increased portal connective tissue, and marked proliferation of interlobular bile ducts and ductules were the most striking histologic features. Histologic cholangitis, although frequent, was generally mild or absent, reflecting the incomplete nature of the duct obstruction. Features of alcoholic liver disease were observed in only two cases. The results indicate that (1) chronic alcoholic pancreatitis with incomplete duct obstruction frequently causes secondary biliary cirrhosis, (2) significant alcoholic liver disease very infrequently coexists with persistent common bile duct stricture from alcoholic pancreatitis, and (3) surgical biliary decompression should be considered in any patient with documented persistent common bile duct stenosis from alcoholic pancreatitis.

Endoscopic evaluation of factors contributing to intrapancreatic biliary stricture in autoimmune pancreatitis

“…Intrapancreatic biliary stricture is sometimes (3%-29%) observed in chronic pancreatitis, [15][16][17] but, as far as we know, such stricture has not been classified as SC. We had thought that pancreatic edema and fibrosis caused intrapancreatic biliary stricture in both chronic pancreatitis and AIP, and its higher frequency in AIP was mainly because of severe edema.…”

Chronic pancreatitis. Multicentre prospective data collection and analysis by the Hungarian Pancreatic Study Group

“…In stage B of chronic pancreatitis, development of common bile duct stricture (CBS) is expected in 3-46% of cases [33][34][35][36][37][38][39][40]; in our cohort, 11% of the patients suffered from jaundice.…”

Pancreatic Diabetes Mellitus and Heavy Drinking are Risk Factors for the Development of Liver Fibrosis in Alcoholic Chronic Pancreatitis

“…The two major causes of chronic liver disease in patients with ACP are alcohol abuse and/or compression of the biliary duct [1,3,[9][10][11]36]. Cholestasis due to the fibrous pancreatic head was an exclusion criterion in our study, and therefore only the toxic etiology of the liver injury was assessed.…”