Skip to main content

Management of Biliary and Duodenal Complications of Chronic Pancreatitis

Abstract

Biliary stricture and duodenal obstruction have been increasingly recognized as complications of chronic pancreatitis. The anatomical relationship of the distal common bile duct and the duodenum with the head of the pancreas is the main factor for their involvement in chronic pancreatitis. In hospitalized patients with pancreatitis, the incidence of biliary stricture and duodenal obstruction is reported to be about 6% and 1.2%, respectively. For patients requiring an operation for chronic pancreatitis the incidence increases to 35% for biliary stricture and 12% for duodenal obstruction. Fibrosis around the distal common bile duct can cause stenosis with obstruction of bile flow. Clinically, the presentation of these patients ranges from being asymptomatic with elevated alkaline phosphatase or bilirubin, or both, to being septic with cholangitis. Jaundice, cholangitis, hyperbilirubinemia, and persistent elevation of serum alkaline phosphatase occur more frequently in patients with pancreatitis with a biliary stricture. A twofold elevation of alkaline phosphatase is a marker of possible common duct stenosis in patients with chronic pancreatitis. The incidence of both biliary cirrhosis and cholangitis in these patients is about 10%. ERCP reveals a characteristic long, smoothly tapered stricture of the intrapancreatic common bile duct. In duodenal obstruction, the factors that convert self-limiting edema to chronic fibrosis and stricture formation are unknown, but ischemia superimposed on inflammation may be the major cause. These patients present with a prolonged history of nausea and vomiting. Barium studies typically show a long constricting lesion of the duodenum, and endoscopy reveals reactive inflammatory changes in a narrowed duodenum. Operation is indicated in patients with common bile duct strictures secondary to chronic pancreatitis when there is evidence of cholangitis, biliary cirrhosis, common duct stones, progression of stricture, elevation of alkaline phophatase and/or bilirubin for over a month, and an inability to rule out cancer. The operation of choice is either choledochoduodenostomy or choledochojejunostomy. A cholecystoenterostomy is less favored because of its higher failure rate (23%). Endoscopic stenting plays a role in patients who are unfit for surgery, but it is not recommended as definitive therapy. For duodenal obstruction, failure to resolve the obstruction with 1–2 weeks of conservative therapy is an indication for bypass. The operation of choice is a gastrojejunostomy. Not uncommonly, combined obstruction of the pancreatic duct, common bile duct, and duodenum will develop. Combined drainage procedures or resection are used to manage these problems.

This is a preview of subscription content, access via your institution.

Fig. 1.
Fig. 2.

References

  1. R Prinz G Aranha H Greenlee (1985) ArticleTitleCombined pancreatic duct and upper gastrointestinal and biliary tract drainage in chronic pancreatitis Arch. Surg. 120 361–366 Occurrence Handle1:STN:280:BiqC387jvVc%3D Occurrence Handle3970672

    CAS  PubMed  Google Scholar 

  2. W Huizinga J Spitaels S Thomson et al. (1992) ArticleTitleChronic pancreatitis with biliary obstruction Ann. R. Coll. Surg. Engl. 74 119–123 Occurrence Handle1:STN:280:By2B3s7ksVc%3D Occurrence Handle1567130

    CAS  PubMed  Google Scholar 

  3. B Stabile R Calabria S Wilson et al. (1987) ArticleTitleStricture of the common bile duct from chronic pancreatitis Surg. Gynecol. Obstet. 165 121–126 Occurrence Handle1:STN:280:BiiB28vgtVc%3D Occurrence Handle3603341

    CAS  PubMed  Google Scholar 

  4. J Sand I Nordback (1995) ArticleTitleManagement of cholestasis in patients with chronic pancreatitis: evaluation of a treatment protocol Eur. J. Surg. 161 587–592 Occurrence Handle1:STN:280:BymD2Mris1U%3D Occurrence Handle8519875

    CAS  PubMed  Google Scholar 

  5. J Petrozza S Dutta (1985) ArticleTitleThe variable appearance of distal common bile duct stenosis in chronic pancreatitis J. Clin. Gastroenterol. 7 447–450 Occurrence Handle1:STN:280:BimD28%2FmvFI%3D Occurrence Handle4067233

    CAS  PubMed  Google Scholar 

  6. G Aranha R Prinz R Freeark et al. (1984) ArticleTitleThe spectrum of biliary tract obstruction from chronic pancreatitis Arch. Surg. 119 595 Occurrence Handle1:STN:280:BiuC2sjpvVE%3D Occurrence Handle6712475

    CAS  PubMed  Google Scholar 

  7. J Petrozza S Dutta P Latham et al. (1984) ArticleTitlePrevalence and natural history of distal common bile duct stenosis in alcoholic pancreatitis Dig. Dis. Sci. 29 890–895 Occurrence Handle1:STN:280:BiqD3czgvVI%3D Occurrence Handle6478979

    CAS  PubMed  Google Scholar 

  8. A Afroudakis N Kaplowitz (1981) ArticleTitleLiver histopathology in chronic common bile duct stenosis due to chronic alcoholic pancreatitis Hepatology 1 65–72 Occurrence Handle1:STN:280:Bi2D38bgs10%3D Occurrence Handle7286890

    CAS  PubMed  Google Scholar 

  9. C Grodsinsky MA Block (1980) ArticleTitlePersistent obstructive jaundice associated with chronic pancreatitis Henry Ford Hosp. Med. J. 28 55–59 Occurrence Handle1:STN:280:Bi2D3s%2FisFw%3D Occurrence Handle7287497

    CAS  PubMed  Google Scholar 

  10. J Yadegar R Williams E Passaro et al. (1980) ArticleTitleCommon duct stricture from chronic pancreatitis Arch. Surg. 115 582–586 Occurrence Handle1:STN:280:Bi%2BC1MjivFU%3D Occurrence Handle7377960

    CAS  PubMed  Google Scholar 

  11. G Littenberg A Afroudakis N Kaplowitz (1979) ArticleTitleCommon bile duct stenosis from chronic pancreatitis: a clinical and pathologic spectrum Medicine (Baltimore) 58 385–412 Occurrence Handle1:STN:280:Bi%2BD2sjisVM%3D

    CAS  Google Scholar 

  12. J Deviere M Cremer M Baize et al. (1994) ArticleTitleManagement of common bile duct stricture caused by chronic pancreatitis with metal mesh self expandable stents Gut 35 122–126 Occurrence Handle1:STN:280:ByuC2c%2FhvFE%3D Occurrence Handle8307432

    CAS  PubMed  Google Scholar 

  13. H Itoh R Shimono K Hamamoto (1988) ArticleTitleEvaluation of common bile duct stenosis in chronic pancreatitis using cholescintigraphy Eur. J. Nucl. Med. 14 137–140 Occurrence Handle1:STN:280:BieB1MnlvFA%3D Occurrence Handle3402503

    CAS  PubMed  Google Scholar 

  14. F Wislooff J Jakobsen M Osnes (1982) ArticleTitleStenosis of the common bile duct in chronic pancreatitis Br. J. Surg. 69 52–54 Occurrence Handle1:STN:280:Bi2D1M3mtFI%3D Occurrence Handle7053803

    CAS  PubMed  Google Scholar 

  15. J Siegel R Sable R Ho et al. (1979) ArticleTitleAbnormalities of the bile duct associated with chronic pancreatitis. Demonstration by ERCP Am. J. Gastroenterol. 72 259–266 Occurrence Handle1:STN:280:Bi%2BD283ksVI%3D Occurrence Handle507029

    CAS  PubMed  Google Scholar 

  16. J Scott A Summerfield E Elias et al. (1977) ArticleTitleChronic pancreatitis: a cause of cholestasis Gut 18 196–201 Occurrence Handle1:STN:280:CSiC28zls1w%3D Occurrence Handle856677

    CAS  PubMed  Google Scholar 

  17. W Huizinga L Baker (1993) ArticleTitleSurgical intervention for regional complications of chronic pancreatitis Int. Surg. 78 315–319 Occurrence Handle1:STN:280:ByuB38boslY%3D Occurrence Handle8175259

    CAS  PubMed  Google Scholar 

  18. L Pereira-Lima A Kalil T Wilson (1989) ArticleTitleSurgical treatment of chronic pancreatic cholangiopathy Br. J. Surg. 76 1129–1131 Occurrence Handle1:STN:280:By%2BD1cbpsVY%3D Occurrence Handle2597966

    CAS  PubMed  Google Scholar 

  19. C Wilson CD Auld R Schlinkert et al. (1989) ArticleTitleHepatobiliary complications in chronic pancreatitis Gut 30 520–527 Occurrence Handle1:STN:280:BiaB3s3ovVU%3D Occurrence Handle2714685

    CAS  PubMed  Google Scholar 

  20. H Sugerman G Barnhart H Newsome (1986) ArticleTitleSelective drainage for pancreatic, biliary, and duodenal obstruction secondary to chronic fibrosing pancreatitis Ann. Surg. 203 558–567 Occurrence Handle1:STN:280:BimB3Mvitlw%3D Occurrence Handle3707234

    CAS  PubMed  Google Scholar 

  21. J Cunha ParticleDa T Bacchella C Mott et al. (1984) ArticleTitleSurgical treatment of biliary complications from calcifying chronic pancreatitis Int. Surg. 69 149–154 Occurrence Handle6500880

    PubMed  Google Scholar 

  22. N Lygidakis (1983) ArticleTitleBiliary stricture as a complication of chronic relapsing pancreatitis Am. J. Surg. 145 804–806 Occurrence Handle1:STN:280:BiyB38fnsFU%3D Occurrence Handle6859419

    CAS  PubMed  Google Scholar 

  23. F Gall C Gebhardt H Zirngibl (1982) ArticleTitleChronic pancreatitis—results in 116 consecutive, partial duodenopancreatectomies combined with pancreatic duct occlusion Hepatogastroenterology 29 115–119 Occurrence Handle1:STN:280:Bi2B28zisFY%3D Occurrence Handle7106696

    CAS  PubMed  Google Scholar 

  24. C Grodsinsky (1980) ArticleTitleSurgical treatment of chronic pancreatitis. a review after a ten year experience Arch. Surg. 115 545–551 Occurrence Handle1:STN:280:Bi%2BC2M3nsFY%3D Occurrence Handle7362467

    CAS  PubMed  Google Scholar 

  25. L Traverso R Tompkins P Urrea et al. (1979) ArticleTitleSurgical treatment of chronic pancreatitis. Twenty-two years experience Ann. Surg. 190 312–319 Occurrence Handle1:STN:280:Bi%2BD3MbjsVI%3D Occurrence Handle485605

    CAS  PubMed  Google Scholar 

  26. CF Frey (1978) ArticleTitlePancreatic pseudocyst—operative strategy Ann. Surg. 188 652–662 Occurrence Handle1:STN:280:CSaD287hs1c%3D Occurrence Handle309751

    CAS  PubMed  Google Scholar 

  27. J Izbicki C Bloechle W Knoefel et al. (1994) ArticleTitleComplications of adjacent organs in chronic pancreatitis managed by duodenum-preserving resection of the head of the pancreas Br. J. Surg. 81 1351–1355 Occurrence Handle1:STN:280:ByqD2c7itVI%3D Occurrence Handle7953411

    CAS  PubMed  Google Scholar 

  28. H Beger M Buchler (1990) ArticleTitleDuodenum-preserving resection of the head of the pancreas in chronic pancreatitis with inflammatory mass in the head World J. Surg. 14 83–87 Occurrence Handle1:STN:280:By%2BC28zksVw%3D Occurrence Handle2305590

    CAS  PubMed  Google Scholar 

  29. A Afroudakis N Kaplowitz (1981) ArticleTitleExtrahepatic obstruction in chronic alcoholic pancreatitis Alcoholism Clin. Exp. Res. 5 110–118 Occurrence Handle1:STN:280:Bi6C1c7nslU%3D

    CAS  Google Scholar 

  30. E Bradley (1986) ArticleTitleParapancreatic biliary and intestinal obstruction in chronic obstructive pancreatitis—is prophylactic bypass necessary? Am. J. Surg. 151 256–258 Occurrence Handle1:STN:280:BimC38jpvVc%3D Occurrence Handle3946760

    CAS  PubMed  Google Scholar 

  31. G Aranha R Prinz H Greenlee et al. (1984) ArticleTitleGastric outlet and duodenal obstruction from inflammatory pancreatic disease Arch. Surg. 119 833 Occurrence Handle1:STN:280:BiuB3s%2FmslI%3D Occurrence Handle6732492

    CAS  PubMed  Google Scholar 

  32. R Kozarek R Sanowski (1981) ArticleTitleDuodenal and common bile duct obstruction in pancreatitis simulating carcinoma J. Clin. Gastroenterol. 3 53–59 Occurrence Handle1:STN:280:Bi2D3cfot1U%3D Occurrence Handle7276492

    CAS  PubMed  Google Scholar 

  33. E Bradley L Clements (1981) ArticleTitleIdiopathic duodenal obstruction—an unappreciated complication of pancreatitis Ann. Surg. 193 638–648 Occurrence Handle7235767

    PubMed  Google Scholar 

  34. S Taylor D Adams M Anderson (1991) ArticleTitleDuodenal stricture: a complication of chronic fibrocalcific pancreatitis South. Med. J. 84 338–341 Occurrence Handle1:STN:280:By6C2MjgsFY%3D Occurrence Handle2000520

    CAS  PubMed  Google Scholar 

  35. A Warshaw (1985) ArticleTitleConservation of pancreatic tissue by combined gastric, biliary, and pancreatic duct drainage for pain from chronic pancreatitis Am. J. Surg. 149 563–569 Occurrence Handle1:STN:280:BiqC2s3ksVM%3D Occurrence Handle2580454

    CAS  PubMed  Google Scholar 

  36. C Frey C Ghild W Fry (1976) ArticleTitlePancreatectomy for Chronic Pancreatitis Ann. Surg. 184 403–413 Occurrence Handle1:STN:280:CSiC3M%2Fos1A%3D Occurrence Handle1015887

    CAS  PubMed  Google Scholar 

  37. G Guillemin J Cuilleret A Michel et al. (1971) ArticleTitleChronic relapsing pancreatitis. Surgical management including sixty-three cases of pancreaticoduodenectomy Am. J. Surg. 122 802–807 Occurrence Handle1:STN:280:CS2D28vjsVE%3D Occurrence Handle5127732

    CAS  PubMed  Google Scholar 

  38. N Fujita Y Shirai K Tsukada et al. (1997) ArticleTitleGroove pancreatitis with recurrent duodenal obstruction Int. J. Pancreatol. 21 185–188 Occurrence Handle1:STN:280:ByiA2MzntF0%3D Occurrence Handle9209960

    CAS  PubMed  Google Scholar 

  39. S Archer S Levitt P Drury (1991) ArticleTitleDuodenal necrosis and intramural haematoma complicating acute pancreatitis Aust. N. Z. J. Surg. 61 542–544 Occurrence Handle1:STN:280:By6A3MrjsVQ%3D Occurrence Handle1859316

    CAS  PubMed  Google Scholar 

  40. J Condit D Wong (1991) ArticleTitleChronic pancreatitis progressing to duodenal obstruction in the absence of classic symptoms Henry Ford Hosp. Med. J. 39 52–55 Occurrence Handle1856103

    PubMed  Google Scholar 

  41. K Satake K Umeyama (1984) ArticleTitleIdiopathic” duodenal obstruction due to chronic pancreatitis Am. Surg. 50 534–537 Occurrence Handle1:STN:280:BiqD38%2FptFY%3D Occurrence Handle6486569

    CAS  PubMed  Google Scholar 

  42. I Schoon R Gamklou (1983) ArticleTitlePersistent duodenal obstruction secondary to pancreatitis Acta Chir. Scand. 149 801–804 Occurrence Handle1:STN:280:BiuC38zpvVY%3D Occurrence Handle6666498

    CAS  PubMed  Google Scholar 

  43. F Makrauer D Antonioli P Banks (1982) ArticleTitleDuodenal stenosis in chronic pancreatitis—clinicopathological correlations Am. J. Dig. Dis. Sci. 27 525–532 Occurrence Handle1:STN:280:Bi2B3M%2FhsVQ%3D

    CAS  Google Scholar 

  44. O Rheingold J Walker J Barkin (1978) ArticleTitleGastric outlet obstruction due to pancreatic pseudocyst Am. J. Gastroenterol. 69 92–96 Occurrence Handle1:STN:280:CSeC28zktVw%3D Occurrence Handle645694

    CAS  PubMed  Google Scholar 

  45. M Blackstone H Mizuno (1977) ArticleTitleReactive duodenal changes in chronic pancreatitis simulating the contiguous spread of pancreatic carcinoma Dig. Dis. 22 658–661 Occurrence Handle1:STN:280:CSiB3MbhsVY%3D

    CAS  Google Scholar 

  46. N Agrawal N Gyr W McDowell et al. (1974) ArticleTitleIntestinal obstruction due to acute pancreatitis Dig. Dis. 19 179–185 Occurrence Handle1:STN:280:CSuD1cjovF0%3D

    CAS  Google Scholar 

  47. H Sheikh (1965) ArticleTitleDuodenal ischaemia complicating acute pancreatitis Br. Med. J. 5449 1539–1540 Occurrence Handle1:STN:280:CCqD1M3mvFY%3D Occurrence Handle14288109

    CAS  PubMed  Google Scholar 

  48. I Nevin (1963) ArticleTitleTransient and persistent duodenal obstruction secondary to acute pancreatitis Wis. Med. J. 62 395–399 Occurrence Handle1:STN:280:CCuD3MznsVY%3D Occurrence Handle14056119

    CAS  PubMed  Google Scholar 

  49. R Brust K Chen (1962) ArticleTitleAcute hemorrhagic pancreatitis complicated by duodenal obstruction Am. J. Roentgenol. Radium Ther. Nucl. Med. 87 732–735

    Google Scholar 

  50. J Sarfeh E Rypins J Jakowatz et al. (1988) ArticleTitleA prospective, randomized clinical investigation of cholecystoenterostomy and choledochoenterostomy Am. J. Surg. 155 411–414 Occurrence Handle1:STN:280:BieC2cfit1Y%3D Occurrence Handle3278638

    CAS  PubMed  Google Scholar 

  51. FE Eckhauser JA Knol WE Strodel et al. (1983) ArticleTitleCommon bile duct strictures associated with chronic pancreatitis Am. Surg. 49 350–358 Occurrence Handle1:STN:280:BiyA3cnot1U%3D Occurrence Handle6614652

    CAS  PubMed  Google Scholar 

  52. H Sarles J Sahel (1978) ArticleTitleCholestasis and lesions of the biliary tract in chronic pancreatitis Gut 19 851–857 Occurrence Handle1:STN:280:CSaD2cnksFM%3D Occurrence Handle361513

    CAS  PubMed  Google Scholar 

  53. D Gremillion L Johnson R Cammerer et al. (1979) ArticleTitleBiliary obstruction: a complication of chronic pancreatitis diagnosed by endoscopic retrograde cholangiopancreatography Dig. Dis. Sci. 24 145–149 Occurrence Handle428303

    PubMed  Google Scholar 

  54. W Schulte A LaPorta R Condon et al. (1977) ArticleTitleChronic pancreatitis: a cause of biliary stricture Surgery 82 303–309 Occurrence Handle1:STN:280:CSiB3snks1U%3D Occurrence Handle888095

    CAS  PubMed  Google Scholar 

  55. S Creaghe D Roseman R Saik (1981) ArticleTitleBiliary obstruction in chronic pancreatitis: indications for surgical intervention Am. Surg. 47 243–246 Occurrence Handle1:STN:280:Bi6B3s%2FltFM%3D Occurrence Handle7247105

    CAS  PubMed  Google Scholar 

  56. T Gadacz K Lillemoe M Zinner et al. (1988) ArticleTitleCommon bile duct complications of pancreatitis evaluation and treatment Surgery 93 235–242

    Google Scholar 

  57. S Singh H Reber (1990) ArticleTitleThe pathology of chronic pancreatitis World J. Surg. 14 2–10 Occurrence Handle1:STN:280:By%2BC28zktlw%3D Occurrence Handle2407035

    CAS  PubMed  Google Scholar 

  58. V Sidel R Wilson J Shipp (1958) ArticleTitlePseudocyst formation in chronic pancreatitis: a cause of obstructive jaundice Arch. Surg. 77 933–937 Occurrence Handle1:STN:280:CyaD38zjvVA%3D

    CAS  Google Scholar 

  59. T Noda N Ueno K Tamada et al. (1994) ArticleTitleA case of chronic pancreatitis with pseudocysts complicated by infection and obstructive jaundice Am. J. Gastroenterol. 89 2066–2069 Occurrence Handle1:STN:280:ByqD38bisFE%3D Occurrence Handle7942739

    CAS  PubMed  Google Scholar 

  60. A Warshaw D Rattner (1980) ArticleTitleFacts and fallacies of common bile duct obstruction by pancreatic pseudocysts Ann. Surg. 192 33 Occurrence Handle1:STN:280:Bi%2BB28vjt1M%3D Occurrence Handle7406561

    CAS  PubMed  Google Scholar 

  61. E Bradley A Salam (1978) ArticleTitleHyperbilirubinemia in inflammatory pancreatic disease: natural history and management Ann. Surg. 188 626–629 Occurrence Handle718287

    PubMed  Google Scholar 

  62. W Short (1977) ArticleTitleDuodenal narrowing associated with chronic pancreatitis Dig. Dis. 22 241–242 Occurrence Handle1:STN:280:CSiC3s7ns1U%3D

    CAS  Google Scholar 

  63. K Lillemoe H Pitt J Cameron (1992) ArticleTitleCurrent management of benign bile duct strictures Adv. Surg. 25 119–174 Occurrence Handle1:STN:280:By2C28%2FntVw%3D Occurrence Handle1536094

    CAS  PubMed  Google Scholar 

  64. TJ Stahl MO Allen HJ Ansel et al. (1988) ArticleTitlePartial biliary obstruction caused by chronic pancreatitis. An appraisal of indications for surgical biliary drainage Ann. Surg. 207 26–32 Occurrence Handle1:STN:280:BieC3crmsVU%3D Occurrence Handle3337559

    CAS  PubMed  Google Scholar 

  65. JA Gregg DL Carr-Locke MM Gallagher (1981) ArticleTitleImportance of common bile duct stricture associated with chronic pancreatitis. Diagnosis by endoscopic retrograde cholangiopancreatography Am. J. Surg. 141 199–203 Occurrence Handle1:STN:280:Bi6C3cjhsVA%3D Occurrence Handle7457737

    CAS  PubMed  Google Scholar 

  66. A Harris M Korsten (1976) ArticleTitleAcute suppurative cholangitis secondary to calcific pancreatitis Gastroenterology 71 847–850 Occurrence Handle1:STN:280:CSiD3cvhsFE%3D Occurrence Handle964577

    CAS  PubMed  Google Scholar 

  67. M Smits E Rauws T Gulick ParticleVan et al. (1996) ArticleTitleLong-term results of endoscopic stenting and surgical drainage for biliary stricture due to chronic pancreatitis Br. J. Surg. 83 764–768 Occurrence Handle1:STN:280:BymA3svot1M%3D Occurrence Handle8696734

    CAS  PubMed  Google Scholar 

  68. M Barthet J Bernard J Duval et al. (1994) ArticleTitleBiliary stenting in benign biliary stenosis complicating chronic calcifying pancreatitis Endoscopy 26 569–572 Occurrence Handle1:STN:280:ByqD1MvntFw%3D Occurrence Handle8001482

    CAS  PubMed  Google Scholar 

  69. J Deviere S Deviere M Baize et al. (1990) ArticleTitleEndoscopic biliary drainage in chronic pancreatitis Gastrointest. Endosc. 36 96–100 Occurrence Handle1:STN:280:By%2BB2czhtlA%3D Occurrence Handle2335299

    CAS  PubMed  Google Scholar 

  70. I Kalvaria R Bornman I Marks et al. (1989) ArticleTitleThe spectrum and natural history of common bile duct stenosis in chronic alcohol-induced pancreatitis Ann. Surg. 210 608–613 Occurrence Handle1:STN:280:By%2BD2Mrkt1Q%3D Occurrence Handle2818030

    CAS  PubMed  Google Scholar 

  71. I Segal H Lawson B Rabinowitz et al. (1982) ArticleTitleChronic pancreatitis and the hepatobiliary system Am. J. Gastroenterol. 77 867–874 Occurrence Handle1:STN:280:BiyD2crmtFE%3D Occurrence Handle7137142

    CAS  PubMed  Google Scholar 

  72. RA Prinz GV Aranha HB Greenlee et al. (1982) ArticleTitleCommon duct obstruction in patients with intractable pain of chronic pancreatitis Am. Surg. 48 373–377 Occurrence Handle1:STN:280:Bi2B1c3ivVI%3D Occurrence Handle7114605

    CAS  PubMed  Google Scholar 

  73. A Warshaw R Schapiro J Ferrucci et al. (1976) ArticleTitlePersistent obstructive jaundice, cholangitis, and biliary cirrhosis due to common bile duct stenosis in chronic pancreatitis Gastroenterology 70 562 Occurrence Handle1:STN:280:CSmC2c%2FmslM%3D Occurrence Handle943356

    CAS  PubMed  Google Scholar 

  74. W Snape W Long B Trotman et al. (1976) ArticleTitleMarked alkaline phosphatase elevation with partial common bile duct obstruction due to calcific pancreatitis Gastroenterology 70 70–73 Occurrence Handle1245286

    PubMed  Google Scholar 

  75. W French (1970) ArticleTitleChronic duodenal obstruction Am. J. Surg. 120 23–26 Occurrence Handle1:STN:280:CS%2BB38bht1I%3D Occurrence Handle5426857

    CAS  PubMed  Google Scholar 

  76. B Newton M Rittenbury M Anderson (1983) ArticleTitleExtrahepatic biliary obstruction associated with pancreatitis Ann. Surg. 197 645–653 Occurrence Handle1:STN:280:BiyB38bovVY%3D Occurrence Handle6859977

    CAS  PubMed  Google Scholar 

  77. C Frey M Suzuki S Isaji (1990) ArticleTitleTreatment of chronic pancreatitis complicated by obstruction of the common bile duct or duodenum World J. Surg. 14 59–69 Occurrence Handle1:STN:280:By%2BC28zksVE%3D Occurrence Handle2407039

    CAS  PubMed  Google Scholar 

  78. K Lillemoe C Yeo (1998) ArticleTitleManagement of complications of pancreatitis Curr. Prob. Surg. 35 1–98 Occurrence Handle1:STN:280:DyaK1c7itl2lsg%3D%3D

    CAS  Google Scholar 

  79. P Amouyal G Amouyal D Mompoint et al. (1989) ArticleTitleEndosonography: promising method for diagnosis of extrahepatic cholestasis Lancet 2 1195–1197 Occurrence Handle1:STN:280:By%2BD2c3oslw%3D Occurrence Handle2572911

    CAS  PubMed  Google Scholar 

  80. T Tio G Tytgat (1986) ArticleTitleEndoscopic ultrasonography of bile duct malignancy and the preoperative assessment of local resectability Scand. J. Gastroenterol. 123 151–157 Occurrence Handle1:STN:280:BiiD2c3ls1E%3D

    CAS  Google Scholar 

  81. H Dancygier M Classen (1986) ArticleTitleEndosonographic diagnosis of benign pancreatic and biliary lesions Scand. J. Gastroenterol. 123 119–122 Occurrence Handle1:STN:280:BiiD2c3ls1Q%3D

    CAS  Google Scholar 

  82. G Lux N Heyder (1986) ArticleTitleEndoscopic ultransonography of the pancreas Scand. J. Gastroenterol. 121 112–118

    Google Scholar 

  83. S Wapnick N Hadas E Purow et al. (1979) ArticleTitleMass in the head of the pancreas in cholestatic jaundice. Carcinoma or pancreatitis? Ann. Surg. 190 587–591 Occurrence Handle1:STN:280:Bi%2BD28vgtVU%3D Occurrence Handle507968

    CAS  PubMed  Google Scholar 

  84. C Reinhold M Bret (1996) ArticleTitleMR cholangiopancreatography Abdominal Imaging 21 105–116 Occurrence Handle10.1007/s002619900025 Occurrence Handle1:STN:280:BymA38vhs1Y%3D Occurrence Handle8661755

    Article  CAS  PubMed  Google Scholar 

  85. D Lomanto P Pavone A Laghi et al. (1997) ArticleTitleMagnetic resonance-cholangiopancreatography in the diagnosis of biliopancreatic diseases Am. J. Surg. 174 33–38 Occurrence Handle10.1016/S0002-9610(97)00022-6 Occurrence Handle1:STN:280:ByiA1c3psFw%3D Occurrence Handle9240949

    Article  CAS  PubMed  Google Scholar 

  86. RE Hintze A Adler W Veltzke et al. (1997) ArticleTitleClinical significance of magnetic resonance cholangiopancreatography (MRCP) compared to endoscopic retrograde cholangiopancreatography (ERCP) Endoscopy 29 182–187 Occurrence Handle1:STN:280:ByiA2crhtVQ%3D Occurrence Handle9201467

    CAS  PubMed  Google Scholar 

  87. HE Adamek M Weitz H Breer et al. (1997) ArticleTitleValue of magnetic-resonance cholangio-pancreatography (MRCP) after unsuccessful endoscopic-retrograde cholangio-pancreatography (ERCP) Endoscopy 29 741–744 Occurrence Handle1:STN:280:DyaK1c%2Fosleltw%3D%3D Occurrence Handle9427493

    CAS  PubMed  Google Scholar 

  88. J Soto M Barish EK Yucel et al. (1996) ArticleTitleMagnetic resonance cholangiography: comparison with endoscopic retrograde cholangiopancreatography Gastroenterology 110 589–597 Occurrence Handle1:STN:280:BymC2Mngs1c%3D Occurrence Handle8566608

    CAS  PubMed  Google Scholar 

  89. P Bearcroft D Lomas (1997) ArticleTitleMagnetic resonance cholangiopancreatography Gut 41 135–137 Occurrence Handle1:STN:280:ByiH2cjgtlM%3D Occurrence Handle9301488

    CAS  PubMed  Google Scholar 

  90. W Nealon F Urrutia (1996) ArticleTitleLong-term follow-up after bilioenteric anastomosis for benign bile duct stricture Ann. Surg. 223 639–645 Occurrence Handle10.1097/00000658-199606000-00002 Occurrence Handle1:STN:280:BymB2crht1w%3D Occurrence Handle8645037

    Article  CAS  PubMed  Google Scholar 

  91. A Oishi M Sarr D Nagorney et al. (1995) ArticleTitleLong term outcome of cholecystoenterostomy as a definitive biliary drainage procedure for benign disease World J. Surg. 19 616–619 Occurrence Handle1:STN:280:ByqH3cjhsl0%3D Occurrence Handle7676709

    CAS  PubMed  Google Scholar 

  92. S Carpenter K Brown (1994) ArticleTitleChronic complications after cholecystojejunsotomy Am. J. Gastroenterol. 89 2073–2075 Occurrence Handle1:STN:280:ByqD38bisFM%3D Occurrence Handle7942741

    CAS  PubMed  Google Scholar 

  93. T Weed J Blalock (1982) ArticleTitleSump syndrome” after choledochoduodenostomy South. Med. J. 75 370–372 Occurrence Handle1:STN:280:Bi2C2MzgsVI%3D Occurrence Handle7063918

    CAS  PubMed  Google Scholar 

  94. J Siegel (1981) ArticleTitleDuodenoscopic sphincterotomy in the treatment of the “sump syndrome Dig. Dis. Sci. 26 922–928 Occurrence Handle1:STN:280:Bi2D38notVM%3D Occurrence Handle7285733

    CAS  PubMed  Google Scholar 

  95. A Escudero-Fabre A Escallon J Sack et al. (1991) ArticleTitleCholedochoduodenostomy Ann. Surg. 213 635–642 Occurrence Handle1:STN:280:By6B2cjovFU%3D Occurrence Handle2039295

    CAS  PubMed  Google Scholar 

  96. R Rutledge (1976) ArticleTitleSphincteroplasty and choledochoduodenostomy for benign biliary obstructions Ann. Surg. 183 476–487 Occurrence Handle1:STN:280:CSmB3cvnt1U%3D Occurrence Handle1275589

    CAS  PubMed  Google Scholar 

  97. E Goldin M Beyar S Globerman et al. (1993) ArticleTitleA new self-expandable and removable metal stent for biliary obstruction—a preliminary report Endoscopy 25 597–599 Occurrence Handle1:STN:280:ByuC28vgsl0%3D Occurrence Handle8119211

    CAS  PubMed  Google Scholar 

  98. D Rattner A Warshaw (1990) ArticleTitleVenous, biliary and duodenal obstruction chronic pancreatitis Hepatogastroenterology 37 301–306 Occurrence Handle1:STN:280:By%2BA38zns1E%3D Occurrence Handle2197206

    CAS  PubMed  Google Scholar 

Download references

Acknowledgments.

We thank Jenny Ho-Vijungco for her assistance in the preparation of this manuscript.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Richard A. Prinz M.D..

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Vijungco, J., Prinz, R. Management of Biliary and Duodenal Complications of Chronic Pancreatitis. World J. Surg. 27, 1258–1270 (2003). https://doi.org/10.1007/s00268-003-7246-7

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00268-003-7246-7

Keywords

  • Pancreatitis
  • Common Bile Duct
  • Chronic Pancreatitis
  • Pancreatic Duct
  • Cholangitis