Cholangiopathy associated with portal hypertension: diagnostic evaluation and clinical implications

There are few studies of biliary changes due to portal hypertension. We ascertained the incidence of such changes on endoscopic retrograde cholangiography and determined the reliability of biochemistry, ultrasonography (US) and hepatobiliary radionuclide scan in detecting this type of cholangiopathy.

Forty-two patients with portal hypertension were studied.

Cholangiopathy was detected by cholangiography in 17 of 20 patients with extrahepatic portal venous obstruction. Abnormalities (mainly strictures and caliber irregularity) were seen in the common bile duct (5) and common hepatic duct (7) and in the right (8) and left (11) hepatic ducts (mainly dilatation). One of 11 patients with noncirrhotic portal fibrosis had a dilated right hepatic duct. Three of 11 patients with cirrhosis had pruned intrahepatic ducts. Eight patients with portal venous obstruction had elevated alkaline phosphatase levels; two had elevated bilirubin levels. US detected gallbladder varices (11) and choledochal varices (9) in patients with extrahepatic portal venous obstruction. Biliary abnormalities were detected on hepatobiliary scintigraphy in 16 of 17 patients.

Cholangiopathy associated with portal hypertension occurs exclusively in patients with extrahepatic portal venous obstruction. It rarely leads to functional obstruction; jaundice does not occur in the absence of functional blockage. Elevated alkaline phosphatase level (after excluding bile duct calculi), presence of gallbladder varices on US, and abnormal radionuclide scans are reliable in detecting these lesions.