The yield of ERCP in symptomatic portal cavernous cholangitis

Aims Our work aimed to determine the yield of ERCP in the management of symptomatic PCC

Methods This was a mono-centric retrospective study conducted over a 6-year period (2016-2023). We included all patients followed for chronic portal thrombosis complicated by PCC and who received endoscopic treatment.

Results Out of the 60 patients followed for portal cavernoma, 25 (41.6%) had PCC, of whom 07 (28%) were symptomatic. The mean age was 44.42 years, ranging from 19 to 84 years, with a clear male predominance (sex ratio 1.3).

The clinical picture was marked by jaundice in 04 patients (57.1%), pruritus in 02 patients (28.6%), and hepatic colic in 28.6% of cases. A history of upper GI hemorrhage was present in 14.3% (n=1) of cases and an anemic syndrome in 28.6% (n=2).

Clinical examination revealed splenomegaly in 100% of cases, collateral venous circulation (CVC) in both flanks and the lower thorax in 71.4% (n=5) of patients, and clinical examination of the liver revealed an hepatomegaly in 71.4% (n=5).

Liver function tests showed cholestasis in all patients, mild cytolysis in 06 cases (85.7%), and hypersplenism in 42.8% (n=3). Upper endoscopy revealed signs of portal hypertension (PH) in 100% of cases.

Abdominal ultrasound combined with Doppler and especially CP-MRI enabled the diagnosis to be made in 100% of cases. The abnormalities found in our patients according to the classification proposed by Chandra et al were dilation of the VBP (type I) in one case (14.2%) and bilateral dilation of the VBIH associated with dilation of the VBP (type IIIb) in 06 cases (85.7%), associated with lithiasis of the VBP in 03 patients (42.8%).

In those with symptomatic PCC, ERCP was performed in 05 cases (71.4%), plastic stenting in two patients (28.6%), plastic stenting after stone extraction in two patients (28.6%), and biliary balloon dilation with plastic stenting in the left and middle hepatic ducts in one patient.

The course of the disease was marked by the disappearance of jaundice and pruritus and an improvement in the liver function tests in all patients, while post-ERCP cholangitis was registered in only one patient.

Conclusions Portal cavernous cholangiopathy is a fairly frequent complication in patients with PCC (41%), which was symptomatic in up to 28% of cases. ERCP is the gold standard for the treatment of symptomatic PCC.

Publication History

Article published online:
15 April 2024