The most common of biliary disorders is gallstone disease.

Biliary (bile) disorders encompass a variety of conditions affecting the bile ducts or gallbladder. Some can cause a problem with the flow of bile from the liver to the small intestines.

The most common of the biliary disorders is gallstone disease. Other diseases include sphincter of Oddi dysfunction (spasm of the muscles that regulate flow from, or narrowing of the opening where the bile and pancreatic ducts empty into the small intestine), primary biliary cirrhosis, primary sclerosing cholangitis (a condition that slowly damages the bile ducts within and outside of the liver), bile duct cancer (cholangiocarcinoma), gallbladder cancer and cancer involving the head of the pancreas.

Scarring can also block the bile ducts, which can lead to liver failure (secondary biliary cirrhosis). This is most commonly related to stones retained in the bile duct. A rare form of bile duct disease called biliary atresia occurs in infants and is the most common reason for liver transplants in children in the United States.

Diagnosis

Blood tests are commonly used to evaluate the health of the liver. Patients with a predominantly obstructive pattern of liver enzymes (cholestasis) typically undergo additional evaluation. Initially, this may be done by an ultrasound of the right upper portion of the abdomen and/or an MRI of the liver and bile ducts. Cholestasis (which literally means “bile standing still”) is a result of interruption of excretion of bile.

Extrahepatic (outside the liver) cholestasis may be due to gallstones, strictures or malignancy. Subsequent testing to identify the underlying cause may include magnetic resonance cholangiopancreatography (MRCP), endoscopic ultrasound (EUS), endoscopic retrograde cholangiopancreatography (ERCP) with or without peroral cholangioscopy (SpyGlass system) and computed tomography (CT).

Diagnostic tests

Diagnostic tests

Endoscopic Retrograde Cholangiopancreatography (ERCP)

In addition to providing access to the bile and pancreatic ducts, this specialized endoscopic procedure can be used to remove biliary stones. A physician may also perform a specialized test to measure the pressure within the sphincter of Oddi (where the bile and pancreatic ducts open into the small intestine).

Magnetic Resonance Cholangiopancreatography (MRCP)

This noninvasive MRI utilizes specific computer software to create images of the bile and pancreatic ducts. Abnormalities can then be further evaluated or treated by ERCP or surgery.

Peroral Cholangioscopy (SpyGlass System)

This comparatively noninvasive endoscopic method can be used for both direct visual diagnostic evaluation and simultaneous therapeutic intervention within the bile duct. During the ERCP, insertion of the SpyGlass system provides a direct view of the bile duct and its contents and allows the physician to obtain a targeted biopsy, if needed. It can also be used to direct electrohydraulic lithotripsy to break large bile duct stones into smaller pieces.

Treatment

Treatment options depend on the specific disease. For gallstones (most common) and related complications, treatment will involve cholecystectomy, which is removal of the gallbladder.

Additional treatments might include ERCP to remove bile duct stones and/or to treat bile duct strictures/narrowing. Other biliary disorders require specific treatments that may involve medical therapy, surgical procedures and/or chemotherapy.

Why Choose Ohio State

Why seek treatment at The Ohio State University Wexner Medical Center?

Our dedication to clinical training, practice and research is a critical part of our program. We provide effective diagnostic options and accurate treatment plans that cure patients and help them lead normal, active and healthy lives. 

We are also at the forefront of treating biliary disorders. For gallstone and related complications, we have advanced endoscopy facilities that utilize EUS, ERCP, peroral cholangioscopy (SpyGlassSystem) and electrohydraulic lithotripsy.

In 2014, Ohio State's Wexner Medical Center received the "2014 Gastrointestinal Care Excellence Award" from Healthgrades, the leading online resource for information about physicians and hospitals. The award recognizes hospitals for superior outcomes in bowel obstruction treatment, colorectal surgeries, gallbladder removal, esophageal/stomach surgeries, treatment of gastrointestinal bleeds, treatment for pancreatitis, and small intestine surgeries. Patients who have these treatments or surgeries at these nationally recognized hospitals have a lower risk of dying or experiencing a complication during their hospital stay.

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