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©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Dec 7, 2016; 22(45): 9909-9920
Published online Dec 7, 2016. doi: 10.3748/wjg.v22.i45.9909
Table 1 Characteristics of four stages in portal biliopathy natural history
Stage Portal cavernoma Biliopathy LFTs Symptoms Complications Preclinic Yes No Normal No No Asymptomatic Yes Early changes Normal or abnormal No No Symptomatic Yes Advanced changes Abnormal Yes No Complicated Yes Advanced changes Abnormal Yes Yes
Table 2 Endoscopic management of portal biliopathy: summary of case series
Ref .No. of patients Biliary abnormalities First treatment Follow-up Further treatments Complications/outcome Bhatia et al [27 ], 1995 4 symptomatic Stenosis + stones 3 CBD stones 4 ES + SE + NBD 4 3-8 mo Multiple ERCP 4 None Perlemuter et al [20 ], 1996 8 symptomatic Stenosis 8 CBD stones 2 Cholangitis 1 ES+NBD 3 BD 1 PSS 1 UDCA 2 6-60 mo Multiple ES 1 Death 2 (cholangitis 1; stroke 1) Condat et al [3 ], 2003 7 symptomatic Cholecystitis/right hypocondrial pain 4 Cholangitis 1 Stenosis 2 Cholecystostomy + SE 1 Stent 1 BA + PTBD 1 UDCA 4 4-25 mo - Haemobilia 1 Sezgin et al [28 ], 2003 10 symptomatic Stenosis 9 IE stones 1 ES + stent 10 NBD 4 BD 4 3.3 yr (range 1-7) Multiple ERCP 5 Haemobilia 1 Cholangitis 5 Death 1 Dumortier et al [22 ], 2003 6 symptomatic Stenosis 5 CBD stones 2 ES 5 BD 5 SE 2 Stent 1 10 mo (range 2 d-18 mo) Multiple ERCP + PSS 4 Cholangitis 1 Cholecystitis 4 Khare et al [25 ], 2005 13 symptomatic Stenosis 10 CBD stones 8 Stent 4 BD 6 SE 4 - PSS 8 BA 1 Multiple ERCP 2 Splenectomy + devasc 2 Death 1 Dhiman et al [29 ], 2007 12 symptomatic Stenosis 7 CBD stones 5 CBD varices 1 Mirizzi’ssdr 1 PSS 5 ES 3 ES + BD 2 Stent 4 19 mo (6-132 mo) Multiple ERCP in pts initially treated with stent Cholangitis in 2 pts treated with stent Vibert et al [30 ], 2007 19 symptomatic IE biliary dilation 9 IE stones 7 CBD stones 4 PSS group: PTBD 1 SRS 10 NPSS group: ES + stent 2 ES + SE 1 PTBD 6 BA 4 19 pts 8.3 yr PSS group: BA 5 NPSS group PTBD 1 after ERCP and 4 after BA Resolution 17 Death 3 Oo et al [17 ], 2009 13 symptomatic Stenosis 13 CBD stones 10 GB stones 11 UDCA 1 Stent 7 ES + SE 1 Failed ERCP 4 2 yr (1-18 aa) Metallic stent 3 Stent exchange 2 PSS 3 (2 TIPS, 1 surgical) LT 1 Haemobilia 2 Sepsis 3 Llop et al [1 ], 2011 14 symptomatic Stenosis 14 CBD stones 6 GB stones 2 ES + SE 6 ES + UDCA 2 Cholecystectomy 2 - Multiple ERCP 1 BA 1 - Saraswat et al [24 ], 2013 20 symptomatic Stenosis 20 CBD stones 8 GB stones 6 ES + SE 8 Stent 9 BD + stent 11 18 mesi (range 3-188) Multiple ERCP 11 In 130 procedures: Cholangitis 40 Haemobilia 9 Ramchandani et al [31 ], 2013 5 symptomatic CBD stenosis 2 CHD stenosis 1 CBD stones 2 Metallic stent 1 Plastic stent 2 BD + stent 1 Intracholedocal lithotripsy 1 6-7 mo SRS 2 Stent Exchange 1 - Resolution 5 Cellich et al [23 ], 2015 8 symptomatic 1 asymptomatic Stenosis 7 CBD stones 3 GB stones 1 ES 7 BD 4 SE 2 Stent 7 - PSS 1 Stent exchange 3 BA 3 Cholangitis 3 Haemobilia 1
Table 3 Endoscopic management of portal biliopathy: summary of case reports
Ref .Patients Biliary abnormalities First treatment Follow-up Further treatment Complications Mörk et al [32 ], 1998 2 CBD stenosis 2 Stent 2 - Multiple Stent exchange + PSS 1 Cholangitis 1 Solmi et al [33 ], 1998 1 Stenosis Stent - - - Mutignani et al [34 ], 2002 3 CBD stenosis 3 Stent 3 - PSS 3 Haemobilia 3 Perego et al [35 ], 2003 1 Stenosis + CBD stones - Stent 3 yr Multiple stent exchange→PTBD + dilation and SE - Umphress et al [15 ], 2004 M, 62 yr IE and CBD stones ES + SE + stent 1 yr Stent exchange and cholecistectomy - Guerrero Hernández et al [36 ], 2005 M, 29 yrs CBD stenosis ERBD + Sugiura - - - Rosenthal et al [37 ], 2008 F, 44 yr CBD stenosis and stones Stent + SE - PSS - Ajayi et al [38 ], 2009 F, 13 yr Stenosis ES + BD + stent 6 mo Multiple stent exchange - Layec et al [39 ], 2009 F, 74 yr Stenosis Metallic stent 18 mo Metallic stent Haemobilia Sharma et al [40 ], 2009 M, 35 yr F, 30 yr M, 25 yr CBD stenosis 3 ES+SE 3 - - Haemobilia 3 Vasiliadis et al [41 ], 2009 F, 39 yr CBD stenosis ES 19 mo Multiple stent exchange→PSS + cholecistectomy - Cantù et al [42 ], 2010 M, 31 yr CBD stenosis ES + stent 4 yr - - Martinez et al [43 ], 2011 M, 34 yr IE diltaions Stent - - - Mistry et al [44 ], 2012 M, 28 yr CBD stenosis BD + BA + PTBD - Percutaneous transhepatic-gastrostomy Haemobilia Alam et al [45 ], 2012 M, 30 yr F, 19 yr CBD stenosis 2 GB stones 1 CBD stones 1 PTBD Stent - Cholecistectomy - D’Souza et al [46 ], 2013 M, 49 yr CBD stenosis Stent + BD (after stent removal) - PSS + splenectomy Haemobilia (post-biopsy) Bernon et al [47 ], 2014 M, 36 yr CBD stenosis and stones SE + stent 1 yr Stent exchange→PTBD→cholecistectomy, intrahepatic 3 semgment bypass Cholangitis Hyun et al [26 ], 2015 M, 33 yr CBD stenosis ERBD→PTBD + portal stent 3 mo - Haemobilia
Table 4 Surgical management of portal biliopathy: summary of case series and case reports
Ref .No. of patients Biliary abnormalities First treatment Follow-up Further treatments Complications/outcome Chaudhary et al [53 ], 1998 9 symptomatic Stenosis: 2 CBD stones: 2 BA 2 SRS 7 9 pts - BA 2 Stent 1 ES + SE 2 Death 1 Resolution 7 Condat et al [3 ], 2003 7 symptomatic Cholecystitis/right hypocondrial pain 4 Cholangitis 1 Stenosis 2 Cholecystostomy + ERCP 1 Stent 1 BA+PTBD 1 4-25 mo - Haemobilia 1 Gauthier-Villars et al [19 ], 2005 8 symptomatic (pediatric) Stenosis 6 Biliarydilation 8 - PSS 8 8 pts 4.5-15 yr - Complete resolution 7 Partial resolution 1 Khare et al [25 ], 2005 13 symptomatic A: Stenosis 5 B: CBD stones 3 C: Stenosis + CBD stones 5 A: PSS 4; BA 1 B: ERCP 2; PSS + BA 1 C: Unsuccessful ERCP 4; PSS 3; Splenectomy + devasc 2 - A: Multiple ERCP: 1 B: Splenectomy 1 (post-ERCP) C: Multiple ERCP 2; BA 1; Splenectomy + BA 1 Death 1 Vibert et al [30 ], 2007 19 symptomatic IE biliary dilation 9 IE stones 7 CBD stones 4 PSS group: PTBD 1 SRS 10 NPSS group: ES + stent 2 ES + SE 1 PTBD 6 BA 4 19 pts 4-30 mo PSS group: BA 5 NPSS group PTBD 1 after ERCP and 4 after BA Resolution 17 Death 3 Dhiman et al [2 ], 2007 12 symptomatic Stenosis: 7 CBD stones: 5 Choledochal varices 2 Mirizzi’ssyndrome 1 PSS 5 ES 3 ES + dilation 2 Stent 4 19 mo (range 6-132) Multiple stent exchange in pts initially treated with stent Cholangitis in 2 pts treated with stent D’Souza et al [54 ], 2009 1 symptomatic CBD stenosis + GB stones Pre-surgery stent→PSS + BA (single stage) 18 mo - Resolution Camerlo et al [51 ], 2010 3 symptomatic Stenosis 3 PSS 3 Stent 1 (pre-PSS) 3 pts 2-13 yr - Resolution 3 Agarwal et al [55 ], 2011 39 symptomatic Stenosis 15 CBD stones 7 GB stones 12 IE dilation 39 SRS 37 BA 2 37 pts 32 mo ES ± SE 10 BA 12 ES + cholecystectomy 1 Resolution 35 Chattopadhyay et al [52 ], 2012 24 symptomatic 32 asymptomatic CBD stenosis 3 Multiple stenosis 5 IE dilation 14 CBD stones 7 GB stones 11 ERCP pre-surgery 12 PSS 40 Splenectomy + devasc. 16 43 pts 48 mo (range 14-120) ES + SE 2 Multiple ES + stent 5 BA 2 Resolution 38 Death 1 Suárez et al [56 ], 2013 3 symptomatic Stenosis 3 UDCA 1 BA 1 - - - Bhatia et al [57 ], 2014 2 symptomatic GB stones Cholecistectomy - - Resolution Liu et al [58 ], 2015 18 Stenosis 6 Dilations 6 Stenosis + dilations 6 PSS 18 - - Resolution 15