Cholangioscopic Characterization of Dominant Bile Duct Stenoses in Patients with Primary Sclerosing Cholangitis

Tischendorf, Jens J. W.; Krüger, Martin; Trautwein, C; Duckstein, N.; Schneider, A.; Manns, Michael P.; Meier, P. N.

doi:10.1055/s-2006-925257

Cited by 200 publications

(100 citation statements)

References 9 publications

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“…Moreover, MRCP has 84% accuracy in estimating the suprahilar extension of a stenotic lesion [12], whereas during ERCP, the inability of the contrast medium to fully penetrate through the strictured bile duct might prohibit this assessment. Given these features, it is certainly not coincidental that MRCP is considered by the experts in our survey as the first-line imaging study in assessing patients with PSC, with almost 60% using it routinely in the pre-transplant work-up [13,14]. …”

Section: Discussionmentioning

confidence: 99%

Trends in Pre-Liver Transplant Screening for Cholangiocarcinoma among Patients with Primary Sclerosing Cholangitis

Trilianos

Selaru²,

Li³

et al. 2014

Digestion

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Background: Cholangiocarcinoma (CCA) is the most common hepatobiliary malignancy complicating primary sclerosing cholangitis (PSC). Unfortunately, timely diagnosis of CCA in PSC patients remains challenging. Aim: To investigate the strategies among liver centers regarding pre-transplant screening for CCA in patients with PSC. Methods: An online survey was returned from 46 US transplant centers, inquiring on the frequency of screening, the use of specific tests, or tactical approaches to high-grade dysplasia (HGD) or CCA. Results: Most centers screen their PSC patients for CCA prior to orthotopic liver transplantation (OLT) (89%). Serum carbohydrate antigen 19-9 and magnetic resonance cholangiopancreatography are first-line screening tools (93 and 84% respectively). Endoscopic retrograde cholangiopancreatography with biliary brushings is routinely performed in only 30% of the centers. In the case of HGD, 61% would choose close monitoring. In the event of non-resectable CCA, 37% have an OLT protocol, 33% resort to palliative treatment and the remaining 30% make an outside referral. Finally, half the participating centers perform CCA surveillance among their listed PSC patients every 6 months. Conclusion: Screening for CCA among PSC patients prior to OLT varies greatly among centers. Serum carbohydrate antigen 19-9 and magnetic resonance cholangiopancreatography are widely used. HGD warrants surveillance rather than intervention among most experts. Protocolized chemoradiation followed by OLT has yet to become a widely accepted approach. The very poor survival of PSC patients who develop CCA underlines the importance of an effective and universally accepted screening process that will aid in its earlier detection.

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Section: Discussionmentioning

confidence: 99%

Trends in Pre-Liver Transplant Screening for Cholangiocarcinoma among Patients with Primary Sclerosing Cholangitis

Trilianos

Selaru²,

Li³

et al. 2014

Digestion

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“…At the time of presentation, approximately 75% of DS are benign, whereas 25% are malignant [31] and PSC is the most common risk factor for CC in western countries [32,][33]. Clinical findings suspicious for malignant transformation are: rapid clinical and biochemical deterioration of liver function tests and the presence of worsening jaundice, pruritus, weight loss, marked proximal ductal dilation with distal bile duct tapering and elevated serum levels of CA 19-9 (>100 U/ml) [34,35].…”

Section: Diagnosis Of Dsmentioning

confidence: 99%

Biliary Stent Therapy for Dominant Strictures in Patients Affected by Primary Sclerosing Cholangitis

Abu-Wasel

Keough

Renfrew³

et al. 2013

Pathobiology

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The diagnosis and the treatment of dominant strictures (DS) in patients with primary sclerosing cholangitis (PSC) is challenging and the scientific literature on the subject is quite limited. Only level II and level III evidence is available to guide physicians managing patients with DS and PSC. For the diagnosis, intraductal endoscopic ultrasound is the most sensitive (64%) and specific (95%) test. However, the majority of cases require a combination of several different diagnostic tests, as there is no single investigation that can rule out malignancy in this group of patients. For the treatment, serial endoscopic or percutaneous dilatations provide 1- and 3-year biliary duct patency in 80 and 60% of patients, respectively. Dilatation and stenting are the most common interventions, although the optimal duration of treatment has still not been clearly defined. Bile duct resection and/or bilioenteric bypass are currently indicated only for patients with preserved liver function. For all other patients, benign DS can be treated with endoscopic dilatation with short-term stenting. This approach is effective and safe and does not increase the risk of malignant transformation or complications for liver transplant candidates. During the last decade, the use of self-expandable metallic stents for benign diseases has become an innovative option. The aim of this article is to review the diagnostic and therapeutic strategies for patients affected by PSC and DS with specific emphasis on the outcomes of patients treated with temporary stents.

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“…Komplikationen der fortgeschrittenen Leberzirrhose, therapierefraktärem Pruritus sowie rezidivierenden bakteriellen Cholangitiden und bei frühem Cholangiokarzinom (CCa; [8]) in Betracht gezogen werden. Patienten, die rechtzeitig transplantiert wurden, haben eine exzellente Prognose [36] [34].…”

Section: Behandlungunclassified

Autoimmune liver diseases

et al. 2009

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Autoimmune hepatitis (AIH) can occur in all age groups. AIH affects women more commonly than men (3:1). Clinical presentation may be an acute hepatitis up to fulminant liver failure, but can also be asymptomatic. AIH is characterized by lymphoplasmacellular infiltrates on liver biopsy, elevated liver enzymes in serum and the absence of active viral markers. Patients characteristically present with hypergammaglobulinemia, elevated serum levels of IgG and autoantibodies. Corticosteroids are the drug of choice for induction of remission, azathioprine the drug of choice for maintenance of remission. Rapid response to immunosuppressive treatment supports the diagnosis and leads to a good long-term prognosis.Primary biliary cirrhosis (PBC) and primary sclerosing cholangitis (PSC) are immune mediated diseases affecting bile ducts. While PBC has a slow progression to cirrhosis and complications mostly will be limited to complications of cirrhosis, PSC additionally carries a high risk of developing cholangiocellular carcinoma. The treatment of choice in PBC and PSC is oral ursodeoxycholic acid which may slow progression of liver disease and may ameliorate lab findings.

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Cholangioscopic Characterization of Dominant Bile Duct Stenoses in Patients with Primary Sclerosing Cholangitis

Abstract: Transpapillary cholangioscopy significantly increases the ability to distinguish between malignant and benign dominant bile duct stenoses in patients with PSC.

Cited by 200 publications

References 9 publications

Trends in Pre-Liver Transplant Screening for Cholangiocarcinoma among Patients with Primary Sclerosing Cholangitis

Trends in Pre-Liver Transplant Screening for Cholangiocarcinoma among Patients with Primary Sclerosing Cholangitis

Biliary Stent Therapy for Dominant Strictures in Patients Affected by Primary Sclerosing Cholangitis

Autoimmune liver diseases

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