Editorial
Copyright ©2012 Baishideng Publishing Group Co., Limited. All rights reserved.
World J Gastroenterol. Nov 21, 2012; 18(43): 6177-6182
Published online Nov 21, 2012. doi: 10.3748/wjg.v18.i43.6177
Portal biliopathy
Somnath Chattopadhyay, Samiran Nundy
Somnath Chattopadhyay, Samiran Nundy, Department of Surgical Gastroenterology and Liver Transplantation, Sir Ganga Ram Hospital, New Delhi 110060, India
Author contributions: Chattopadhyay S contributed to the conception and design of the editorial, along with the writing of the manuscript; Nundy S contributed to the conception and design of the editorial, along with critically revising it for important intellectual content and gave final approval of the version to be published.
Correspondence to: Dr. Samiran Nundy, Chairman, Department of Surgical Gastroenterology and Liver Transplantation, Sir Ganga Ram Hospital, New Delhi 110060, India. snundy@hotmail.com
Telephone: +91-98-11117507 Fax: +91-11-42252224
Received: February 21, 2012
Revised: May 24, 2012
Accepted: June 8, 2012
Published online: November 21, 2012
Abstract

Biliary ductal changes are a common radiological finding in patients with portal hypertension, however only a small percentage of patients (5%-30%) develop symptomatic bile duct obstruction. The exact pathogenesis is not clear, but an involvement of factors such as bile duct compression by venous collaterals, ischemia, and infection is accepted by most authors. Although endoscopic retrograde cholangiopancreatography was used to define and diagnose this condition, magnetic resonance cholangiopancreatography is currently the investigation of choice for diagnosing this condition. Treatment is indicated only for symptomatic cases. Portosystemic shunts are the treatment of choice for symptomatic portal biliopathy. In the majority of patients, the changes caused by biliopathy resolve after shunt surgery, however, 15%-20% patients require a subsequent bilio-enteric bypass or endoscopic management for persistent biliopathy. There is a role for endoscopic therapy in patients with bile duct stones, cholangitis or when portosystemic shunt surgery is not feasible.

Keywords: Pseudosclerosing cholangitis; Non cirrhotic portal fibrosis; Extrahepatic portal venous obstruction; Proximal lienorenal shunt; Biliary obstruction; Portal cavernoma