Is suprastenotic dilatation a mandatory symptom of impaired bile outflow?

Objective: to study the rate, nature, and symptoms of bile flow impairments running without developing suprastenotic dilatation.

Material and methods. A total of 1082 patients undergoing endoscopic retrograde cholangiopancreatography for the differential diagnosis of jaundices were followed up. According to the diameter of the common bile duct, the patients were classified into cholangioectasia and non-cholangioectasia groups. The investigators studied the causes of bile evacuation disorders; the levels of bilirubin, hepatic transferases, and alkaline phosphatase; the duration and periodicity of obstructive jaundice; еxtended compression of suprastenotic dilatation; the occurrence of other symptoms; and the efficiency of additional procedures for the differential diagnosis of hepatic and obstructive jaundices.

Results. There was no suprastenotic dilatation in 11 cases: in noncircular   amorphous internal hepatocholedochal blocks, in cicatrical stenoses of the hepatocholedoch, in excessive metastatic spread into the hepatic portal and parenchyma, extended stenosis of the common bile duct does not lead to intrahepatic cholangiectasia. In 9 cases, instrumental palpation and aspiration biopsy were used to visualize common bile duct stenosis in order to elucidate its nature, degree, and rigidity. Endobiliary stenting was employed for the differential diagnosis of jaundices.

Conclusion. No suprastenotic dilatation was seen in 0.8% of patients with organic bile flow impairment. In these cases, obstacles to bile flow may be suggested by clear-cut variations in the diameter of the hepaticocholedoch and its deformity. The absence of suprastenotic dilatation may be partly explained by excessive metastatic liver involvement and malignant hepatoduodenal ligament infiltration. When suprastenotic dilatation is absent, instrumental palpation and diagnostic and therapeutic stenting may be used for the differential diagnosis of obstructive and hepatic jaundices.

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