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Subtypes and clinical significance of common bile duct varices in portal vein thrombosis: diagnosis and follow-up by Doppler US and EUS

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Abstract

Purpose

To investigate (1) diagnostic performance of transabdominal color doppler ultrasound (US) and endoscopic ultrasound (EUS) for detection and sub-classification of common bile duct varices (CBDV) in patients with portal vein thrombosis (PVT), and (2) clinical significance and natural history of CBDV subtypes.

Patients and Methods

During a 4-year period, 56 patients with PVT underwent US and EUS for the presence and subtypes of CBDV. Natural history was analyzed for patients who attended control visits.

Results

CBDV were diagnosed in 57 and 59 % of patients with US and EUS, respectively. In 19 % of patients, EUS revealed different CBDV subtypes than previously seen by US. The most common were paracholedochal (PCV), while the least common were epicholedochal (ECV) and Submucosal varices (SMV). Nine patients had obstructive jaundice and underwent ERCP which was complicated by hemobilia in two patients with SMV. Among eight patients who underwent control EUS (median follow-up 60 months), the form of CBDV remained unchanged. Two patients bled from esophageal varices, both with ECV.

Conclusion

While abdominal US and EUS are equally sensitive for detection of CBDV, EUS allows more precise determination of CBDV subtype. Patients with SMV might be at increased risk of bleeding upon ERCP.

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Abbreviations

CBD:

Common bile duct

CBDV:

Common bile duct varices

ECV:

Epicholedochal varices

ERCP:

Endoscopic retrograde cholangiopancreatography

EUS:

Endoscopic ultrasound

EV:

Esophageal varices

MRI:

Magnetic resonance imaging

MSCT:

Multi-sliced computerized tomography

PVC:

Paracholedochal varices

PECV:

Para- and epicholedochal varices

PVT:

Portal vein thrombosis

SMV:

Submucosal varices

US:

Abdominal ultrasound

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Authors and Affiliations

  1. Division of Liver Diseases, Department of Gastroenterology, University Hospital Dubrava, University of Zagreb School of Medicine, Av. Gojka Suska 6, 10 000, Zagreb, Croatia

    Ivica Grgurevic, Milan Kujundzic, Marko Banic & Tomislav Bokun

  2. Faculty of Pharmacy and Biochemistry, University of Zagreb School of Medicine, Zagreb, Croatia

    Ivica Grgurevic, Milan Kujundzic & Tomislav Bokun

  3. University of Rijeka School of Medicine, Rijeka, Croatia

    Marko Banic

  4. Department of Hematology and Division of Molecular Diagnostics and Genetics, University Hospital Dubrava, University of Zagreb School of Medicine, Zagreb, Croatia

    Rajko Kusec

  5. Department of Diagnostic and Interventional Radiology, University Hospital Dubrava, University of Zagreb School of Medicine, Zagreb, Croatia

    Mirjana Vukelic-Markovic & Boris Brkljacic

  6. Department of Medicine, Jacobi Medical Centre, Albert Einstein School of Medicine, New York, NY, USA

    Zoran Bogdanovic

  7. Intensive Care Unit, Varazdin General Hospital, Varazdin, Croatia

    Anita Lukic

  8. UCL Institute for Liver and Digestive Health, Royal Free Hospital, London, United Kingdom

    Emmanouil Tsochatzis

Authors
  1. Ivica Grgurevic
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  2. Milan Kujundzic
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  3. Marko Banic
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  4. Rajko Kusec
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  5. Tomislav Bokun
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  6. Mirjana Vukelic-Markovic
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  7. Zoran Bogdanovic
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  8. Anita Lukic
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  9. Emmanouil Tsochatzis
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  10. Boris Brkljacic
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Corresponding author

Correspondence to Ivica Grgurevic.

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Cite this article

Grgurevic, I., Kujundzic, M., Banic, M. et al. Subtypes and clinical significance of common bile duct varices in portal vein thrombosis: diagnosis and follow-up by Doppler US and EUS. Abdom Radiol 41, 476–484 (2016). https://doi.org/10.1007/s00261-015-0596-4

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  • DOI: https://doi.org/10.1007/s00261-015-0596-4

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