Abstract
Background
Benign biliary obstruction (BBO) is an important complication in patients with advanced chronic pancreatitis (CP). Its presentation varies from an incidental finding to overt jaundice. Thus it presents certain management issues. The present study was therefore performed to analyze the clinical presentation and management of biliary obstruction in patients with CP.
Methods
Retrospective analysis was performed from a prospectively collected database of 155 CP patients managed at our institute from October 2003 to June 2012.
Results
Among 43 (28 %) CP patients with biliary obstruction, 3 patients had evidence of malignancy on follow-up examination and were excluded from the final analysis. The various presentations include chronic nonprogressive elevation of serum alkaline phosphatase (SAP) (n = 15), a progressive increase in SAP with episodes of jaundice (n = 17), and persistent jaundice (n = 8). Of 15 patients with chronic nonprogressive elevation of SAP, 5 were managed conservatively, and the remaining 10 underwent only a pancreatic drainage procedure. During a median follow-up of 41 months (range 11–90 months), none of the 15 patients developed complications related to biliary obstruction. All patients with progressive increase in SAP levels and persistent jaundice underwent the biliary drainage procedure [choledochojejunostomy (CDJ, n = 20) and choledochoduodenostomy (CDD, n = 3)]. During a median follow-up of 30 months (range 10–89 months), two patients died of unrelated causes and two patients had an asymptomatic elevation of SAP.
Conclusions
BBO is common in patients with CP; however, biliary drainage is not indicated for chronic nonprogressive elevation of SAP. In patients with a progressive increase in SAP or persistent jaundice, both CDJ and CDD provide effective biliary drainage.
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References
Aranha GV, Prinz RA, Freeark RJ et al (1984) The spectrum of biliary tract obstruction from chronic pancreatitis. Arch Surg 119:595–600
Huizinga WK, Thomson SR, Spitaels JM et al (1992) Chronic pancreatitis with biliary obstruction. Ann R Coll Surg Engl 74:119–123
Wisloff F, Jakobsen J, Osnes M (1982) Stenosis of the common bile duct in chronic pancreatitis. Br J Surg 69:52–54
Abdallah AA, Krige JE, Bornman PC (2007) Biliary tract obstruction in chronic pancreatitis. HPB (Oxf) 9:421–428
Warshaw AL, Schapiro RH, Ferrucci JT Jr et al (1976) Persistent obstructive jaundice, cholangitis, and biliary cirrhosis due to common bile duct stenosis in chronic pancreatitis. Gastroenterology 70:562–567
Frey CF, Suzuki M, Isaji S (1990) Treatment of chronic pancreatitis complicated by obstruction of the common bile duct or duodenum. World J Surg 14:59–69. doi:10.1007/BF01670547
Stahl TJ, Allen MO, Ansel HJ et al (1988) Partial biliary obstruction caused by chronic pancreatitis. An appraisal of indications for surgical biliary drainage. Ann Surg 207:26–32
Kalvaria I, Bornman PC, Marks IN et al (1989) The spectrum and natural history of common bile duct stenosis in chronic alcohol-induced pancreatitis. Ann Surg 210:608–613
Segal I, Lawson HH, Rabinowitz B et al (1982) Chronic pancreatitis and the hepatobiliary system. Am J Gastroenterol 77:867–874
Vijungco JD, Prinz RA (2003) Management of biliary and duodenal complications of chronic pancreatitis. World J Surg 27:1258–1270. doi:10.1007/s00268-003-7246-7
Petrozza JA, Dutta SK, Latham PS et al (1984) Prevalence and natural history of distal common bile duct stenosis in alcoholic pancreatitis. Dig Dis Sci 29:890–895
Weed T, Blalock J (1982) “Sump syndrome” after choledochoduodenostomy. South Med J 75:370–372
Scott J, Summerfield JA, Elias E et al (1977) Chronic pancreatitis: a cause of cholestasis. Gut 18:196–201
Sarles H, Sahel J (1978) Cholestasis and lesions of the biliary tract in chronic pancreatitis. Gut 19:851–857
Sidel VW, Wilson RE, Shipp JC (1958) Pseudocyst formation in chronic pancreatitis: a cause of obstructive jaundice. Arch Surg 77:933
Da Cunha JE, Bacchella T, Mott CB et al (1984) Surgical treatment of biliary complications from calcifying chronic pancreatitis. Int Surg 69:149–154
Devière J, Devaere S, Baize M et al (1990) Endoscopic biliary drainage in chronic pancreatitis. Gastrointest Endosc 36:96–100
Farnbacher MJ, Rabenstein T, Ell C et al (2000) Is endoscopic drainage of common bile duct stenoses in chronic pancreatitis up-to-date? Am J Gastroenterol 95:1466–1471
Kahl S, Zimmermann S, Genz I et al (2003) Risk factors for failure of endoscopic stenting of biliary strictures in chronic pancreatitis: a prospective follow-up study. Am J Gastroenterol 98:2448–2453
Cahen DL, Rauws EA, Gouma DJ et al (2008) Removable fully covered self-expandable metal stents in the treatment of common bile duct strictures due to chronic pancreatitis: a case series. Endoscopy 40:697–700
Waldthaler A, Schütte K, Weigt J et al (2013) Long-term outcome of self expandable metal stents for biliary obstruction in chronic pancreatitis. JOP 14:57–62
Strate T, Bachmann K, Busch P et al (2008) Resection vs drainage in treatment of chronic pancreatitis: long-term results of a randomized trial. Gastroenterology 134:1406–1411
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Saluja, S.S., Kalayarasan, R., Mishra, P.K. et al. Chronic Pancreatitis with Benign Biliary Obstruction: Management Issues. World J Surg 38, 2455–2459 (2014). https://doi.org/10.1007/s00268-014-2581-4
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DOI: https://doi.org/10.1007/s00268-014-2581-4