Endoscopic transpapillary intraductal ultrasonography and biopsy in the diagnosis of IgG4-related sclerosing cholangitis

Naitoh, Itaru; Nakazawa, Takahiro; Ohara, Hirotaka; Ando, Tomoaki; Hayashi, Kazuki; Tanaka, Hajime; Okumura, Fumihiro; Takahashi, Satoru; Joh, Takashi

doi:10.1007/s00535-009-0108-9

Cited by 146 publications

(164 citation statements)

References 19 publications

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“…7,8 Naitoh et al reported that lower bile duct strictures appeared as marked wall thickening in 93% of patients, and as extrinsic compression in 7% of patients, revealing lower bile duct stricture caused mostly by bile duct wall thickening. 12 Other 14 studies also support that lower bile duct stricture in AIP is due to inflammatory processes in the bile duct. 20,21 Pathological studies of resected tissue specimens from the pancreatic head revealed abundant lymphoplasmacytic and IgG4-bearing plasma cell infiltration not only in pancreatic tissue, but also in the bile duct wall, indicating that the lower bile duct stricture lesion was due to IgG4-related inflammatory processes in the lower bile duct.…”

Section: Discussionmentioning

confidence: 91%

“…Because IDUS showed continuous wall thickening from the lower to middle bile ducts, IgG4-related inflammatory changes in the bile duct seem to extend from the lower to middle bile duct in most cases even though cholangiography showed normal findings. 12 Middle bile duct stricture co-occurred with lower bile duct stricture in cholangiography for 4 cases. Thus, stenotic change in 4 middle bile duct cases appeared to share a common mechanism of IgG4-related biliary wall inflammation with lower bile duct stricture, suggesting that simultaneous lower bile duct stricture and middle bile duct stricture represents dominant IgG4-related bile 16 duct inflammation.…”

Section: Discussionmentioning

confidence: 99%

“…12 Though some patients received stent treatment for obstructive jaundice, ERCP and IDUS procedures were done for these patients before stenting. Bile duct biopsy of the lower bile duct lesion was performed at least three times using biopsy forceps (FB-45Q-1; Olympus Optical Co.).…”

Section: Study Subjectsmentioning

confidence: 99%

“…IgG4-related inflammatory changes occurring with bile duct stricture appear to extend from the lower to middle bile duct in these 4 cases and exert a dominant effect on lower bile duct stricture. 12 …”

Section: Co-occurrence Of Middle Bile Duct Stricturementioning

confidence: 99%

“…11 In contrast, other reports support classifying these lesions as IgG4-SC based on wall thickening revealed by intraductal ultrasonography (IDUS) or IgG4-bearing plasma cell infiltration in the affected tissues. 12 In recently proposed Japanese diagnostic criteria for IgG4-SC, lower bile duct stricture was classified as IgG4-SC. 9 Some lower bile duct stricture lesions found in AIP are resistant to corticosteroid therapy, and residual lesions require more intensive therapy.…”

Section: Introductionmentioning

confidence: 99%

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Mechanisms of Lower Bile Duct Stricture in Autoimmune Pancreatitis

Watanabe

Maruyama²,

Ito³

et al. 2014

Pancreas

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ObjectivesWe attempted to clarify the mechanism underlying lower bile duct stricture in autoimmune pancreatitis. MethodsImaging and histology of the bile duct were assessed for 73 patients with autoimmune pancreatitis to clarify whether IgG4-related biliary inflammation or pancreatic head swelling is associated with lower bile duct stricture. ResultsLower bile duct stricture was found in 59 patients (81%). Pancreatic head swelling was significantly more frequent among patients with lower bile duct stricture than those without (53 (90%) versus 4 (29%); p<0.01). Intraductal ultrasonography revealed lower bile duct wall thickening in 21 of 22 patients with lower bile duct stricture (95%), and lower bile duct wall of patients with pancreatic head swelling was significantly thicker than those without (p=0.028). Among 38 patients with lower bile duct biopsies, 14 (37%) exhibited abundant IgG4-bearing plasma cell infiltration. Among lower bile duct 4 stricture patients, an IgG4-related inflammation seemed to exert a dominant effect under limited conditions, including concomitant middle bile duct stricture and neither pancreatic swelling nor pancreatic duct stricture in the head region. ConclusionsBoth pancreatic head swelling and IgG4-related biliary inflammation influence the occurrence of lower bile duct stricture, which may be included in IgG4-related sclerosing cholangitis. Pancreatic head swelling affects IgG4-related biliary wall thickening.

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Section: Discussionmentioning

confidence: 91%

Section: Discussionmentioning

confidence: 99%

Section: Study Subjectsmentioning

confidence: 99%

Section: Co-occurrence Of Middle Bile Duct Stricturementioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Mechanisms of Lower Bile Duct Stricture in Autoimmune Pancreatitis

Watanabe

Maruyama²,

Ito³

et al. 2014

Pancreas

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Benign hilar bile duct strictures resected as perihilar cholangiocarcinoma

Otsuka

Yokoyama

Igami

et al. 2019

British Journal of Surgery

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Background: Differentiation between perihilar cholangiocarcinoma (PHCC) and benign strictures is frequently difficult. The aim of this study was to investigate the incidence and long-term outcome of patients with tumours resected because of suspicion of PHCC, which ultimately turned out to be benign (malignancy masquerade). Methods: Patients who underwent surgical resection with a diagnosis of PHCC between 2001 and 2016 were reviewed retrospectively. Results: Among 707 consecutive patients, 685 had PHCC and the remaining 22 (3⋅1 per cent) had benign biliary stricture. All patients with benign disease underwent major hepatectomy, with no deaths. Preoperative histological assessment using bile duct biopsy or aspiration cytology had a high specificity (90 per cent), low sensitivity (62 per cent) and unsatisfactory accuracy (63 per cent). Despite the increasing use of histological assessment, the incidence of benign strictures resected did not decrease over time, being 0⋅9 per cent in 2001-2004, 4⋅0 per cent in 2005-2008, 3⋅8 per cent in 2009-2012 and 2⋅9 per cent in 2013-2016. The final pathology of benign strictures included IgG4-related sclerosing cholangitis (9 patients), hepatolithiasis (4), granulomatous cholangitis (3), non-specific chronic cholangitis (3), benign strictures after cholecystectomy (2), and a benign stricture possibly caused by parasitic infection (1). The 10-year overall survival rate for the 22 patients with benign stricture was 87 per cent, without recurrence of biliary stricture.Conclusion: The incidence of benign strictures resected as PHCC as a proportion of all resections was relatively low, at 3⋅1 per cent. Currently, unnecessary surgery for suspected PHCC is unavoidable.

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Clinical practice guidelines for IgG4‐related sclerosing cholangitis

Kamisawa

Nakazawa

Tazuma

et al. 2019

J Hepato Biliary Pancreat

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112

143

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IgG4‐related sclerosing cholangitis (IgG4‐ SC ) is a distinct type of cholangitis frequently associated with autoimmune pancreatitis and currently recognized as a biliary manifestation of IgG4‐related disease. Although clinical diagnostic criteria of IgG4‐ SC were established in 2012, differential diagnosis from primary sclerosing cholangitis and cholangiocarcinoma is sometimes difficult. Furthermore, no practical guidelines for IgG4‐ SC are available. Because the evidence level of most articles retrieved through searching the PubMed, Cochrane Library, and Igaku Chuo Zasshi databases was below C based on the systematic review evaluation system of clinical practice guidelines MINDS 2014, we developed consensus guidelines using the modified Delphi approach. Three committees (a guideline creating committee, an expert panelist committee for rating statements according to the modified Delphi method, and an evaluating committee) were organized. Eighteen clinical questions ( CQ s) with clinical statements were developed regarding diagnosis (14 CQ s) and treatment (4 CQ s). Recommendation levels for clinical statements were set using the modified Delphi approach. The guidelines explain methods for accurate diagnosis, and safe and appropriate treatment of IgG4‐ SC .

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Endoscopic transpapillary intraductal ultrasonography and biopsy in the diagnosis of IgG4-related sclerosing cholangitis

Cited by 146 publications

References 19 publications

Mechanisms of Lower Bile Duct Stricture in Autoimmune Pancreatitis

Mechanisms of Lower Bile Duct Stricture in Autoimmune Pancreatitis

Benign hilar bile duct strictures resected as perihilar cholangiocarcinoma

Clinical practice guidelines for IgG4‐related sclerosing cholangitis

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