Regression of liver fibrosis after biliary drainage in patients with chronic pancreatitis and stenosis of the common bile duct

Background: Chronic obstruction of the common bile duct may cause hepatic fibrosis and secondary biliary cirrhosis. Methods: We studied liver-biopsy specimens from 11 patients with chronic stenosis of the common bile duct due to chronic pancreatitis; all the patients had undergone liver biopsy before or at the time of surgical biliary decompression and underwent a subsequent liver biopsy for various clinical reasons. The patients were followed as part of a prospective study of 501 patients who had been treated for chronic pancreatitis. Two pathologists, who were unaware of the sequence of specimens, graded fibrosis on a scale of 0 (none) to 3 (cirrhosis). Results: The 11 patients were all men. Chronic pancreatitis was due to alcohol abuse in 10 of the men; 1 had idiopathic disease. The median age at diagnosis was 38 years. The median interval between the first and second liver biopsies was 2.5 years (range, 0.3 to 9.0). The two patients who had restenosis of the biliary anastomosis were excluded from the analysis of fibrosis. In the group of nine patients without restenosis, the second specimen showed significant improvement in fibrosis (P = 0.01). The fibrosis improved by two grades in two patients and by one grade in four patients; in three patients, the grade did not change. The pathologists agreed on the grading of specimens from 10 of the 11 patients. Conclusions: In patients with chronic pancreatitis and stenosis of the common bile duct, liver fibrosis may regress after biliary drainage. (N Engl J Med 2001;344:418-23.) Copyright (C) 2001 Massachusetts Medical Society.