Portal Hypertensive Biliopathy in Adult Patients: Findings and Interventional Radiologic Treatment—A Single-Center Experience

Abstract

The aim of this study was to evaluate the morphologic appearance, the clinical scenario, and the outcomes of patients with portal hypertensive biliopathy (PHB), particularly in the symptomatic subgroup treated with interventional radiology (IR) procedures. The outcome of 20 patients with PHB were retrospectively reviewed over a 5-year period. In all cases, the extrahepatic portal vein occlusion (EHPVO) and the compensatory cavernomatosis was the cause of PHB. Eight out of 20 patients had severe symptoms (jaundice and bleeding). Five out of these eight patients were successfully treated with IR procedures. PHB is a rare but serious complication of PH from EHPVO. IR treatments are highly effective in controlling symptoms. Moreover, IR procedures, as drainage and transjugular intrahepatic portosystemic shunt placement, are the first-line treatment in cases of life-threatening bleeding from ruptures of the varices.

Whole clinical process in a patient with portal hypertensive biliopathy: a case report

“…Percutaneous or surgical treatment also can be considered in patients with severe symptoms. 6 The ideal therapeutic goal is to control the portal venous pressure. Multiple complications caused by portal hypertension, such as bleeding from esophageal and gastric varices and refractory ascites, can be treated effectively by TIPS.…”

“…5 Bleeding of esophageal varices with resultant severe hemobilia is relatively rare. 6 Treatment options for PHB are limited. The patient described in this case report underwent nearly all known treatment methods.…”

Ictericia colestásica secundaria a biliopatía hipertensiva portal, a propósito de un caso con cavernomatosis portal

“…La biliopatía hipertensiva portal comprende las anomalías anatómicas y funcionales del tracto biliar intra-y extrahepático, el conducto cístico y la vesícula biliar en pacientes con hipertensión portal (1) . La alteración de las vías biliares ocurre más frecuentemente en el contexto de obstrucción de la vena porta extrahepática (OVPEH) debido a la transformación cavernomatosa de la misma que comprime par-ticularmente al conducto biliar común (2) . Esta entidad se ha denominado con distintos términos como biliopatía portal (portal biliopathy), colangiopatía asociada a hipertensión portal (cholangiopathy associated with portal hypertension) o colangiopatía asociada a cavernoma portal (portal cavernoma-associated cholangiopathy); sin embargo, actualmente el término más aceptado es biliopatía hipertensiva portal (portal hypertensive biliopathy) (1) .…”

Safety and efficacy of transjugular intrahepatic portosystemic shunt therapy for symptomatic portal biliopathy

“…4 TIPS improves peribiliary vascular plexus varicosis in treating PB and makes therapeutic ERCP safer by reducing the risk of hemobilia. 5 However, the TIPS procedure may be rather difficult because of the cavernous transformation of the portal vein and biliary dilatation. In our cohort, the continuation of PTCD-TIPS-ERCP was an effective and safe strategy for complicated PB accompanied by severe esophagogastric varices and biliary dilatation.…”