Portal cholangiopathy: radiological classification and natural history

Abstract

PC is a frequent complication that develops and stabilises early after PVT and becomes symptomatic in its more severe form (grade III). These data suggest that follow-up MRA/MRC is not mandatory and strategies to prevent the development of symptoms of PC should be tested in patients with grade III PC.

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).…”

“…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). 5,[9][10][11]18 While increased prevalence of gallstones in PCC remains inadequately explained, it appears that biliary stasis due to collateral compression or stricture formation results in the high prevalence of biliary calculi and that formation of these calculi may precipitate biliary obstruction and trigger symptoms in patients with PCC. 9,10 MANAGEMENT Endoscopic clearance of CBD calculi in patients with PCC was first reported by Bhatia and Sarin in 1995.…”

“…5,[9][10][11]18 While increased prevalence of gallstones in PCC remains inadequately explained, it appears that biliary stasis due to collateral compression or stricture formation results in the high prevalence of biliary calculi and that formation of these calculi may precipitate biliary obstruction and trigger symptoms in patients with PCC. 9,10 MANAGEMENT Endoscopic clearance of CBD calculi in patients with PCC was first reported by Bhatia and Sarin in 1995. 8 In three years, they managed 4 patients with PCC and choledocholithiasis, two of whom developed cholangitis.…”

“…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.…”