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Portal cholangiopathy: radiological classification and natural history
  1. Elba Llop1,
  2. Carmen de Juan2,
  3. Susana Seijo1,
  4. Ángeles García-Criado2,
  5. Juan G Abraldes1,3,
  6. Jaume Bosch1,3,
  7. Juan Carlos García-Pagán1,3
  1. 1Hepatic Hemodynamic Laboratory, Liver Unit, Institut de Malalties Digestives i Metaboliques, Hospital Clínic-Institut de Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
  2. 2Centre de Diagnostic per l'Imatge, Hospital Clinic, Barcelona, Spain
  3. 3Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Barcelona, Spain
  1. Correspondence to Juan Carlos García-Pagán, Hepatic Hemodynamic Laboratory, Liver Unit, Hospital Clínic, Villarroel 170, Barcelona 08036, Spain; jcgarcia{at}clinic.ub.es

Abstract

Background/aim Portal cholangiopathy (PC) is identified in over 80% of patients with portal vein thrombosis (PVT), but the true impact of this condition is not well known. This study investigated the relationship between cholangiographic abnormalities and clinical symptoms and their evolution over time.

Patients/methods 67 consecutive patients with non-tumoral non-cirrhotic PVT following a standardised diagnostic protocol were studied. Findings at magnetic resonance angiography and cholangiography (MRA/MRC) were classified as no PC, grade I PC (minimal irregularities), grade II PC (stenosis without dilation) and grade III PC (stenosis with dilation). These changes were related to the presence of symptoms.

Results 22 patients were diagnosed with acute PVT and 45 presented with chronic PVT. Overall, 52 patients had PC (6 grade I, 12 grade II and 34 grade III). 14 patients developed symptoms, all of whom had grade III PC. 30% of patients with acute PVT developed grade III PC within 1 year. In those without grade III PC, follow-up MRC showed no progression of the biliary lesions to grade III. The 5-year probability of developing symptoms of PC after acute PVT was 19%. In 45 patients with chronic PVT, MRA/MRC showed grade III PC in 26. In those without grade III PC, no progression of PC was observed at further follow-up MRC. The prevalence of symptoms of PC in these patients was 22%.

Conclusions PC is a frequent complication that develops and stabilises early after PVT and becomes symptomatic in its more severe form (grade III). These data suggest that follow-up MRA/MRC is not mandatory and strategies to prevent the development of symptoms of PC should be tested in patients with grade III PC.

  • Portal biliopathy
  • haemostatic disorders
  • portal cavernoma
  • portal hypertension
  • portal hypertension
  • radiology

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Footnotes

  • Funding Supported in part by grants from Ministerio de Educación y Ciencia (SAF-10/17043) and from Instituto de Salud Carlos III (PI 09/01261). CIBERehd is funded by Instituto de Salud Carlos III. EL has received financial support from the Fundación Banco Bilbao Vizcaya Argentaria.

  • Competing interests None.

  • Patient consent Obtained.

  • Ethics approval This study was conducted with the approval of the ethical committee of the Hospital Clinic, Barcelona.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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