Skip to main content
PMC home page
Annals of Surgery logoLink to Annals of Surgery
. 1988 Jan;207(1):26–32. doi: 10.1097/00000658-198801000-00007

Partial biliary obstruction caused by chronic pancreatitis. An appraisal of indications for surgical biliary drainage.

T J Stahl 1, M O Allen 1, H J Ansel 1, J A Vennes 1
PMCID: PMC1493263  PMID: 3337559

Abstract

This paper presents a retrospective review of 38 patients with intrapancreatic bile duct strictures secondary to chronic alcoholic pancreatitis. The strictures were identified by endoscopic retrograde cholangiopancreatography (ERCP). All patients with pancreatic cancer and gallstone pancreatitis were excluded. The mean alkaline phosphatase and total bilirubin values were 344 +/- 57 IU/dl and 4.4 +/- 0.7 mg/dl, respectively. The mean stricture length was 3.9 +/- 0.5 cm, and the mean common bile duct (CBD) diameter was 1.8 +/- 0.2 cm. The degree of bilirubin and alkaline phosphatase elevation did not correlate with stricture length or the severity of bile duct dilatation. Eighteen of the 38 patients received surgical biliary drainage (BD) as part of their initial therapy, and 20 patients did not. Liver function tests, intrapancreatic stricture length, and the degree of proximal CBD dilation were comparable in these two groups. Patients not undergoing BD did well clinically as only one patient required BD over an average follow-up period of 3.8 years. In conclusion, bypass of these strictures is usually unnecessary, and most patients may be safely treated without operation.

Full text

PDF
26

Images in this article

27Fig. 1.
on p.27
27Fig. 2.
on p.27
28Fig. 3.
on p.28
28Fig. 4.
on p.28

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. Gremillion D. E., Jr, Johnson L. F., Cammerer R. C., Guider B. Biliary obstruction: a complication of chronic pancreatitis diagnosed by endoscopic retrograde cholangiopancreatography (ERCP). Dig Dis Sci. 1979 Feb;24(2):145–149. doi: 10.1007/BF01324742. [DOI] [PubMed] [Google Scholar]
  8. 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]
  9. 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]
  10. 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]
  11. 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]
  12. 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]
  13. 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]
  14. 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]
  15. 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]
  16. 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]
  17. 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]
  18. da Cunha J. E., Bacchella T., Mott C. B., Jukemura J., Abdo E. E., Machado M. C. Surgical treatment of biliary complications from calcifying chronic pancreatitis. Int Surg. 1984 Apr-Jun;69(2):149–154. [PubMed] [Google Scholar]

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

RESOURCES