engleski

Common bile duct varices in patients with portal vein thrombosis : diagnosis and characterisation by abdominal and endoscopic color doppler ultrasound with follow-up data

Different diagnostic modalities have been used so far in order to investigate prevalence, subtypes and clinical significance of common bile duct varices (CBDV) in patients with portal vein thrombosis (PVT), offering conflicting data on this issue. The primary aim of this study was to investigate different subtypes and the prevalence of CBDV in patients with PVT by using transabdominal (TUS) and endoscopic color Doppler ultrasound (CDEUS). The secondary aim was to evaluate the natural history of CBDV in these patients. During a 4-year period 56 patients with PVT were diagnosed by TUS, which was confirmed by multi-sliced computed tomographic (MSCT) portography. All patients were examined by TUS and CDEUS for the presence of common bile duct variceal vein collaterals. Common bile duct varices were diagnosed by TUS in 57% (32/56) and by CDEUS in 59% (33/56) of patients. In 19% (6/32) of patients the subtype of the CBDV diagnosed by CDEUS was different than previously seen by TUS. The most common subtypes were paracholedochal (PCV), followed by paracholedochal and epicholedochal combined (PECV), then epicholedochal (ECV) alone with submucosal varices (SMV) being the least frequent. In 18% (10/56) of patients an obstructive jaundice was present. An endoscopic retrograde cholangiopancreatography (ERCP) with sphyncterotomy and endobiliary stent placement was performed in 16% (9/56) of patients, complicated by hemobilia in 2 patients (both with SMV). Ten patients were followed during a period of 9 to 48 months. Among them 8 patients underwent control CDEUS examination revealing no change of the CBDV subtype and 2 patients developed bleeding from esophageal varices (EV), both with ECV subtype of CBDV. Although the CDEUS is more precise, both TUS and CDEUS are equally good and sensitive in the detection of the CBDV. Thus, in everyday practice the patients should be first screened for such condition by TUS. For more details, spatial relations of varices and ampullary region or common bile duct wall, especially in patients with obstructive jaundice, a CDEUS should be attempted. This may be clinically very important before planning the strategy of ERCP intervention, during which submucosal form of CBDV are more likely to bleed. The subtype of CBDV remains unchanged over time. Patients with ECV might be at increased risk for EV bleeding.

common bile duct varices; portal vein thrombosis

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