Partial Biliary Obstruction Caused by Chronic Pancreatitis

Abstract

This paper presents a retrospective review of 38 patients with intrapancreatic bile duct strictures secondary to chronic alcoholic pancreatitis. The strictures were identified by endoscopic retrograde cholangiopancreatography (ERCP). All patients with pancreatic cancer and gallstone pancreatitis were excluded. The mean alkaline phosphatase and total bilirubin values were 344 +/- 57 IU/dl and 4.4 +/- 0.7 mg/dl, respectively. The mean stricture length was 3.9 +/- 0.5 cm, and the mean common bile duct (CBD) diameter was 1.8 +/- 0.2 cm. The degree of bilirubin and alkaline phosphatase elevation did not correlate with stricture length or the severity of bile duct dilatation. Eighteen of the 38 patients received surgical biliary drainage (BD) as part of their initial therapy, and 20 patients did not. Liver function tests, intrapancreatic stricture length, and the degree of proximal CBD dilation were comparable in these two groups. Patients not undergoing BD did well clinically as only one patient required BD over an average follow-up period of 3.8 years. In conclusion, bypass of these strictures is usually unnecessary, and most patients may be safely treated without operation.

Pathologico-Anatomic Categories of Choledochal End-Piece Stenosis Due to Chronic Pancreatitis and Clinical Significance

“…Whichever has possibility to cause choledochal endpiece stenosis and lead to obvious dilatation in proximal bile duct, as long as leision implicates pancreatic head. Its incidence rate is 3% -46% in patients with CP [5,[8][9][10][11][12][13][14]. The majority of the reports are about 25%.…”

“…CP cause the end of the common bile duct stricture is a non-metabolic complications, and also one of common situations of biliary duct stenosis. So far, documented CP cause the end of the common bile duct stenosis which is more general, reported only one type, namely fixed circular narrow [5,6]. The narrow, however, can not explain any CP concurrency in bile duct expansion, but surgery with Bake's dilator and French catheter probe, pancreatic biliary no significant stenosis of practical problems.…”

Biliary tract obstruction in chronic pancreatitis

“…Although several studies have reported a significant risk of development of secondary biliary cirrhosis 1, 2, 6, 30, other series have not confirmed this finding 5, 31–33. Frey et al [28] found that the average incidence of biliary cirrhosis associated with CBDS was 7.3% (Table II) 1, 2, 5, 6, 9, 14, 30–34, and in four of the studies 5, 31–33 in their collected series no patients had biliary cirrhosis.…”

“…The wide variation in the reported incidence, which ranges from 3% to 46%1–8 (Table I), occurs because not all patients with biliary obstruction in CP present with jaundice. The jaundice may frequently be transient [9], and in an appreciable number of patients the bile duct stricture is discovered incidentally 10–14.…”

“…In jaundiced patients, management will be determined whether jaundice is transient, recurrent, or persistent [32]. A conservative approach is warranted for transient jaundice, which is frequently self‐limiting due to resolution of edema or a pseudocyst in the head 1, 7, 10–12, 14, 26, 31, 57. Spontaneous resolution of jaundice occurs within 1 month in 20–50% of patients 4, 7, 9, 11, 31.…”