Complications of Endoscopic Retrograde Cholangiopancreatography in Primary Sclerosing Cholangitis

Bangarulingam, Sanjay Y.; Gossard, Andrea A.; Petersen, Bret T.; Ott, Beverly J.; Lindor, Keith D.

doi:10.1038/ajg.2008.161

Cited by 135 publications

(112 citation statements)

References 19 publications

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“…ERCP carries an increased risk for complications in the context of PSC, especially pancreatitis, cholangitis and extravasation of contrast, although not all the studies were documented such an increased risk in PSC (69,74). In the systematic survey (75) of post-ERCP complications on various indications for ERCP including 21 prospective studies and 16,855 patients the number of total complications was 6.85% (CI 6.46-7.24%).…”

Section: Esge/easl Suggest That Ercp In Psc Patients Should Be Undertmentioning

confidence: 99%

“…Several studies have evaluated the risk of complications in PSC patients undergoing ERCP (63)(64)(65)(66)(67)(68)(69)(70)(71)(72)(73)(74). ERCP carries an increased risk for complications in the context of PSC, especially pancreatitis, cholangitis and extravasation of contrast, although not all the studies were documented such an increased risk in PSC (69,74).…”

Section: Esge/easl Suggest That Ercp In Psc Patients Should Be Undertmentioning

confidence: 99%

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Role of endoscopy in primary sclerosing cholangitis: European Society of Gastrointestinal Endoscopy (ESGE) and European Association for the Study of the Liver (EASL) Clinical Guideline

Aabakken¹,

Karlsen²,

Albert³

et al. 2017

Journal of Hepatology

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Section: Esge/easl Suggest That Ercp In Psc Patients Should Be Undertmentioning

confidence: 99%

Section: Esge/easl Suggest That Ercp In Psc Patients Should Be Undertmentioning

confidence: 99%

Role of endoscopy in primary sclerosing cholangitis: European Society of Gastrointestinal Endoscopy (ESGE) and European Association for the Study of the Liver (EASL) Clinical Guideline

Aabakken¹,

Karlsen²,

Albert³

et al. 2017

Journal of Hepatology

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“…However the risk of cholangitis was significantly higher and the duration of the procedure was significantly longer in subjects with PSC (Bangarulingam et al 2009). …”

Section: Clinical Features and Diagnosismentioning

confidence: 95%

Primary Sclerosing Cholangitis

Milkiewicz

2011

Inflammation and Gastrointestinal Cancers

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Primary sclerosing cholangitis (PSC) is a chronic liver condition which may affect both intra and extrahepatic biliary tree. Etiology of PSC remains to be fully elucidated but genetic, autoimmune, inflammatory and possibly infective factors could all contribute to its development. More than two-thirds of patients are males and the most commonly associated condition is an inflammatory bowel disease which occurs in up to 70% of affected subjects. Endoscopic cholangiopancreatography (ERCP) and magnetic resonanse cholangiopancreatography (MRCP) remain a gold standard in the diagnosis of this condition. No curative treatment of PSC exists and a proportion of patients who develop liver failure or suffer from recurrent episodes of cholangitis requires liver transplantation. PSC is associated with increased risk of malignancies, in particular cholangiocarcinoma which may arise in 12% of patients. The main aim of this chapter is to review the current knowledge on pathogenesis and clinical aspects of PSC as well as its associated malignancies.

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“…In several series, the risk of complications in PSC patients undergoing endoscopic procedures has been addressed, and the benefit considerably outweighs the risks in those patients [31,32]. …”

Section: Treatment Of Dominant Stricturesmentioning

confidence: 99%

Primary Sclerosing Cholangitis: Diagnostic and Therapeutic Problems

Gotthardt¹,

Chahoud²,

Sauer³

2011

Dig Dis

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Progressive destruction of bile ducts in primary sclerosing cholangitis (PSC) may lead to end-stage liver disease, portal hypertension and liver failure. The diagnosis of PSC is made by characteristic multifocal stricturing and dilation of intrahepatic and/or extrahepatic bile ducts observed by cholangiography. Magnetic resonance cholangiography is considered to have comparable accuracy to endoscopic retrograde cholangiography (ERC) in the diagnosis of PSC, but its accuracy is limited in early stages of PSC. Up to 60% of patients with PSC develop a dominant stricture of the intra- or extrahepatic biliary tree. Patients may present with jaundice, pruritus or ascending cholangitis. Therefore, in patients with an increase in serum bilirubin and/or worsening pruritus, progressive bile duct dilation on imaging studies and/or cholangitis seen via ERC, it is recommended to exclude a dominant stricture. However, in a considerable number of patients without symptoms, a dominant stricture can be detected on the cholangiogram. The cholangiographic findings and the clinical presentation make it difficult to distinguish PSC from cholangiocarcinoma. The accuracy in the distinction between these two conditions is still rather disappointing, despite the combined use of imaging, endoscopic biopsy, and cytology. Medical, endoscopic, and surgical therapies aim to slow the progression of the disease. It is generally agreed upon that patients with symptoms from dominant strictures like cholangitis, jaundice, pruritus or worsening biochemical indices are candidates for endoscopic therapy. Although the best therapeutic endoscopic approach for these patients is still under discussion, a number of reports have documented clinical and radiographic improvement in patients following endoscopic dilation with or without placement of a biliary stent. Furthermore, indirect evidence by retrospective studies suggests that endoscopic therapy may improve survival.

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Complications of Endoscopic Retrograde Cholangiopancreatography in Primary Sclerosing Cholangitis

Cited by 135 publications

References 19 publications

Role of endoscopy in primary sclerosing cholangitis: European Society of Gastrointestinal Endoscopy (ESGE) and European Association for the Study of the Liver (EASL) Clinical Guideline

Role of endoscopy in primary sclerosing cholangitis: European Society of Gastrointestinal Endoscopy (ESGE) and European Association for the Study of the Liver (EASL) Clinical Guideline

Primary Sclerosing Cholangitis

Primary Sclerosing Cholangitis: Diagnostic and Therapeutic Problems

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