Role of biliary SEMS as therapeutic intervention in portal cavernous cholangiopathy (PCC) with hepatobiliarylithiasis: experience from single tertiary care centre.

Abstract

Background and aim: Biliary changes seen in PCC may be due to compression by large collaterals or may be ischaemic, due to portal vein thrombosis and/or prolonged biliary compression. While the former are reversible after porto-systemic shunt surgery, the latter are not. A small percentage (5-38%) of patients present with recurrent cholangitis, related to the presence of biliary strictures or stones. Stone extraction is difficult in presence of choledochal varices and strictures. With this realisation we are assessing the role of biliary self expandable metallic stent (SEMS) in PCC patients.

Methods: We prospectively investigated 15 Extrahepatic portal vein obstruction (EHPVO) patients with symptomatic PCC in form of dominant CBD stricture with stones. All patients were managed by placement of 8 cm biliary FC-SEMS, planned to be kept for 10-12 months.

Results: EHPVO patients examined (male/female, 8/7) , median age of presentation with portal biliopathy was 28 with mean follow-up of patients after placement of SEMS is 1.2 years (9 months-1.5 yrs) .

Stent remained in place for the defined time in 9/15 (60%) patients, stent migration seen at 3-6 months duration in 3/15 (20%) patients. Changes in biliary tree in form of opening of strictures on serial cholangiography in 11/15 (73%) patients, complete and partial clearance of CBD and/or IHDs in 10/15 (67%) and 3/15 (20%) patients respectively over 27 ERCP sessions. Number of cholangitis episodes requiring ERCPs after placement of SEMS were total 12 in 6/15 (40%) patients. Migration of SEMS in 3/15 (20%) , papillotomy bleed in 3/15 (20%) with post ERCP sepsis seen in 2/15 (13%) patients.

Conclusion: Biliary SEMS has been found to be an effective therapeutic intervention in terms of significant reduction in the number of ERCP sessions for clearance of CBD and IHDs alongwith opening of CBD strictures.