Skip to main content
PMC home page
Annals of Surgery logoLink to Annals of Surgery
. 1989 Nov;210(5):608–613. doi: 10.1097/00000658-198911000-00007

The spectrum and natural history of common bile duct stenosis in chronic alcohol-induced pancreatitis.

I Kalvaria 1, P C Bornman 1, I N Marks 1, A H Girdwood 1, L Bank 1, R E Kottler 1
PMCID: PMC1357794  PMID: 2818030

Abstract

Sixty patients with chronic alcohol-induced pancreatitis with endoscopic retrograde cholangiopancreatography evidence of common bile duct stenosis were studied to determine the clinical spectrum and natural history of this complication, as well as the indications for biliary bypass. In 17% of patients, common bile duct stenosis (CBDS) was an incidental finding at ERCP, while in the remaining cases pain and jaundice were the predominant symptoms in 35% and 48%, respectively. Biliary drainage was performed in 38% of patients for persistent or recurrent jaundice, cholangitis, and while undergoing pancreatic duct or cyst drainage procedures for pain. The benign nature of CBDS in chronic alcohol-induced pancreatitis (CAIP) in patients without persistent jaundice is emphasized. In particular, no histologically proved cases of secondary biliary cirrhosis were noted. The majority of patients with CBDS due to CAIP may be safely managed without biliary bypass but require close follow-up.

Full text

PDF
611

Images in this article

610Fig. 1.
on p.610
610Fig. 2.
on p.610
611Fig. 3.
on p.611

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Afroudakis A., Kaplowitz N. Liver histopathology in chronic common bile duct stenosis due to chronic alcoholic pancreatitis. Hepatology. 1981 Jan-Feb;1(1):65–72. doi: 10.1002/hep.1840010111. [DOI] [PubMed] [Google Scholar]
  2. Aranha G. V., Prinz R. A., Freeark R. J., Greenlee H. B. The spectrum of biliary tract obstruction from chronic pancreatitis. Arch Surg. 1984 May;119(5):595–600. doi: 10.1001/archsurg.1984.01390170091018. [DOI] [PubMed] [Google Scholar]
  3. Bradley E. L., 3rd, Salam A. A. Hyperbilirubinemia in inflammatory pancreatic disease: natural history and management. Ann Surg. 1978 Nov;188(5):626–629. doi: 10.1097/00000658-197811000-00007. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. Creaghe S. B., Roseman D. M., Saik R. P. Biliary obstruction in chronic pancreatitis: indications for surgical intervention. Am Surg. 1981 Jun;47(6):243–246. [PubMed] [Google Scholar]
  5. Eckhauser F. E., Knol J. A., Strodel W. E., Achem S., Nostrant T. Common bile duct strictures associated with chronic pancreatitis. Am Surg. 1983 Jul;49(7):350–358. [PubMed] [Google Scholar]
  6. Gregg J. A., Carr-Locke D. L., Gallagher M. M. Importance of common bile duct stricture associated with chronic pancreatitis. Diagnosis by endoscopic retrograde cholangiopancreatography. Am J Surg. 1981 Feb;141(2):199–203. doi: 10.1016/0002-9610(81)90156-2. [DOI] [PubMed] [Google Scholar]
  7. HOLLINSHEAD W. H. The lower part of the common bile duct: a review. Surg Clin North Am. 1957 Aug;37(4):939–952. doi: 10.1016/s0039-6109(16)35232-x. [DOI] [PubMed] [Google Scholar]
  8. Littenberg G., Afroudakis A., Kaplowitz N. Common bile duct stenosis from chronic pancreatitis: a clinical and pathologic spectrum. Medicine (Baltimore) 1979 Nov;58(6):385–412. doi: 10.1097/00005792-197911000-00001. [DOI] [PubMed] [Google Scholar]
  9. MARKS I. N., BANK S. THE AETIOLOGY, CLINICAL FEATURES AND DIAGNOSIS OF PANCREATITIS IN THE SOUTH WESTERN CAPE; A REVIEW OF 243 CASES. S Afr Med J. 1963 Oct 19;37:1039–1053. [PubMed] [Google Scholar]
  10. McCollum W. B., Jordan P. H. Obstructive jaundice in patients with pancreatitis without associated biliary tract disease. Ann Surg. 1975 Aug;182(2):116–120. doi: 10.1097/00000658-197508000-00005. [DOI] [PMC free article] [PubMed] [Google Scholar]
  11. Newton B. B., Rittenbury M. S., Anderson M. C. Extrahepatic biliary obstruction associated with pancreatitis. Ann Surg. 1983 Jun;197(6):645–653. doi: 10.1097/00000658-198306000-00002. [DOI] [PMC free article] [PubMed] [Google Scholar]
  12. Petrozza J. A., Dutta S. K. The variable appearance of distal common bile duct stenosis in chronic pancreatitis. J Clin Gastroenterol. 1985 Oct;7(5):447–450. doi: 10.1097/00004836-198510000-00018. [DOI] [PubMed] [Google Scholar]
  13. Prinz R. A., Aranha G. V., Greenlee H. B. Combined pancreatic duct and upper gastrointestinal and biliary tract drainage in chronic pancreatitis. Arch Surg. 1985 Mar;120(3):361–366. doi: 10.1001/archsurg.1985.01390270099017. [DOI] [PubMed] [Google Scholar]
  14. Sarles H., Sahel J. Cholestasis and lesions of the biliary tract in chronic pancreatitis. Gut. 1978 Sep;19(9):851–857. doi: 10.1136/gut.19.9.851. [DOI] [PMC free article] [PubMed] [Google Scholar]
  15. Schulte W. J., LaPorta A. J., Condon R. E., Unger G. F., Geenen J. E., DeCosse J. J. Chronic pancreatitis: a cause of biliary stricture. Surgery. 1977 Sep;82(3):303–309. [PubMed] [Google Scholar]
  16. Scott J., Summerfield J. A., Elias E., Dick R., Sherlock S. Chronic pancreatitis: a cause of cholestasis. Gut. 1977 Mar;18(3):196–201. doi: 10.1136/gut.18.3.196. [DOI] [PMC free article] [PubMed] [Google Scholar]
  17. Segal I., Lawson H. H., Rabinowitz B., Hamilton D. G. Chronic pancreatitis and the hepatobiliary system. Am J Gastroenterol. 1982 Nov;77(11):867–874. [PubMed] [Google Scholar]
  18. Siegel J. H., Sable R. A., Ho R., Balthazar E. J., Rosenthal W. S. Abnormalities of the bile duct associated with chronic pancreatitis. Am J Gastroenterol. 1979 Sep;72(3):259–266. [PubMed] [Google Scholar]
  19. Stabile B. E., Calabria R., Wilson S. E., Passaro E., Jr Stricture of the common bile duct from chronic pancreatitis. Surg Gynecol Obstet. 1987 Aug;165(2):121–126. [PubMed] [Google Scholar]
  20. Stahl T. J., Allen M. O., Ansel H. J., Vennes J. A. Partial biliary obstruction caused by chronic pancreatitis. An appraisal of indications for surgical biliary drainage. Ann Surg. 1988 Jan;207(1):26–32. doi: 10.1097/00000658-198801000-00007. [DOI] [PMC free article] [PubMed] [Google Scholar]
  21. Sugerman H. J., Barnhart G. R., Newsome H. H. Selective drainage for pancreatic, biliary, and duodenal obstruction secondary to chronic fibrosing pancreatitis. Ann Surg. 1986 May;203(5):558–567. doi: 10.1097/00000658-198605000-00017. [DOI] [PMC free article] [PubMed] [Google Scholar]
  22. WEINSTEIN B. R., KORN R. J., ZIMMERMAN H. J. Obstructive jaundice as a complication of pancreatis. Ann Intern Med. 1963 Feb;58:245–258. doi: 10.7326/0003-4819-58-2-245. [DOI] [PubMed] [Google Scholar]
  23. Warshaw A. L., Rattner D. W. Facts and fallacies of common bile duct obstruction by pancreatic pseudocysts. Ann Surg. 1980 Jul;192(1):33–37. doi: 10.1097/00000658-198007000-00006. [DOI] [PMC free article] [PubMed] [Google Scholar]
  24. Warshaw A. L., Schapiro R. H., Ferrucci J. T., Jr, Galdabini J. J. Persistent obstructive jaundice, cholangitis, and biliary cirrhosis due to common bile duct stenosis in chronic pancreatitis. Gastroenterology. 1976 Apr;70(4):562–567. [PubMed] [Google Scholar]
  25. Wisløoff F., Jakobsen J., Osnes M. Stenosis of the common bile duct in chronic pancreatitis. Br J Surg. 1982 Jan;69(1):52–54. doi: 10.1002/bjs.1800690117. [DOI] [PubMed] [Google Scholar]
  26. Yadegar J., Williams R. A., Passaro E., Jr, Wilson S. E. Common duct stricture from chronic pancreatitis. Arch Surg. 1980 May;115(5):582–586. doi: 10.1001/archsurg.1980.01380050012004. [DOI] [PubMed] [Google Scholar]

Articles from Annals of Surgery are provided here courtesy of Lippincott, Williams, and Wilkins

RESOURCES