BRIEF CLINICAL OBSERUATION DlGESTLlUER DIS 2002;34:587.91 Endoscopic treatment of extrahepatic bile duct strictures in patients with portal biliopathy carries a high risk of haemobilia: report of 3 cases M. Mutignani S.K. Shah A. Bruni V. Perri G. Costamagna Extrahepatic portal venous obstruction can be associated with bile duct abnormalities, the entity being called portal biliopathy Three cases are re- ported of extrahepatic bile duct strictures in patients with portal biliopathy who developed haemobilia during endotherapy Although endoscopic ther- apy with stent placement can be successful in patients with portal bil- iopathy and could also lead to permanent stricture resolution, procedure- related haemobilia is not as uncommon as previously held. Shunt surgery could be a better option in fit patients, since it could provide definitive treatment in a young patient with an otherwise normal life expectancy Digest Liver Dis 2002;34:587-91 Key words: bile duct stricture; endotherepy; extrahepatic portal venous obstruction; haemo- bilia; portal biliopathy Introduction “Portal biliopathy” describes extrahepatic and intrahepatic bile duct abnor- malities in patients with portal hypertension, especially those with extrahep- atic portal venous obstruction (EHPVO). Bile duct abnormalities have been reported in SO-100% of patients with EHPVO lm3. Clinical obstruction is un- common and most cases have only biochemical features of cholestasis ’ *. However, a few of these patients are symptomatic, most being young adults. Several cases have now been described in the literature ‘-15. The postulated causes for biliary obstruction include extrinsic compression on the common bile duct (CBD) by paracholedochal and epicholedochal plexus collaterals 2 3, calcification within the collateral vessels 9, pericholedochal fibrosis at the porta 3, and ischaemic necrosis of the bile ducts 3. Cholangiographic abnor- malities affecting the extra- and intra-hepatic bile ducts include strictures, calibre irregularity, segmental upstream dilation, ectasia, extrinsic impres- sions, duct displacement, angulation and pruning 3 16. Once symptomatic, therapy is warranted to prevent the occurrence of long-stand- , From ing cholestasis, which could eventually lead to secondary biliary cirrhosis 4. The Digestive Endoscopy Unit, CsGtroic main therapeutic options available are surgical and endoscopic. Experience University S80-u CuareU, 1. GemN with endoscopic therapy in this setting is limited to a few reports 4-‘o17. Two of LInkersiCy Hospital, Rome, lcaiy. these single case reports showed a risk of haemobilia during the therapeutic en- doscopic retrograde cholangiopancreatography (ERCP) procedure lo I’. MdmBA?P We report our experience in 3 cases of portal biliopathy who underwent Prof.G. Costamagna, Unit& di Endascopia Digestiva, Policlinico “A. &me///“, Large A. stent placement and developed haemobilia during endoscopic therapy. Gemelli 8, 00168 Roma,My. Fax: +39-06-35511515. E-mail: gcostamagna@rm. unicatt. it Case reports Submitted October 29, 2001. Accepted after revision January P’I( 200; Case 1 PG, a 39-year-old male, with EHPVO since childhood, presented in No- vember 1996 with jaundice. He had undergone splenectomy in 1963.