Lack of complications following short-term stent therapy for extrahepatic bile duct strictures in primary sclerosing cholangitis

Wit, A.W.M. van Milligen de; Rauws, E. A. J.; Bracht, Jeroen van; Mulder, Cjj; Jones, Edward; Tytgat, G. N. J.; Huibregtse, K.

doi:10.1016/s0016-5107(97)70123-8

Cited by 69 publications

(33 citation statements)

References 11 publications

(3 reference statements)

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“…Development of a DS is a common complication of PSC that can portend a diagnostic challenge as well as significant morbidity and mortality 16, 17, 18. Nevertheless, consensus on the definition of a DS, indications for and means of further evaluation and treatment, and appropriate follow‐up has yet to be established.…”

Section: Discussionmentioning

confidence: 99%

Dominant strictures in primary sclerosing cholangitis: A multicenter survey of clinical definitions and practices

Hilscher

Tabibian

Carey

et al. 2018

Hepatology Communications

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Dominant strictures (DSs) of the biliary tree occur in approximately 50% of patients with primary sclerosing cholangitis (PSC) and may cause significant morbidity. Nevertheless, the definition and management of DSs lacks consensus. We aimed to better understand current perceptions and practices regarding PSC‐associated DSs. We conducted an anonymous, 23‐question, survey‐based study wherein electronic surveys were distributed to 131 faculty in the Division of Gastroenterology and Hepatology at the three Mayo Clinic campuses (Rochester, Scottsdale, and Jacksonville) as well as the affiliated practice network. Responses were aggregated and compared, where applicable, to practice guidelines of the American Association for the Study of Liver Diseases and European Association for the Study of the Liver. A total of 54 faculty (41.2%) completed the survey, of whom 24 (44.4%) were hepatologists, 21 (38.9%) gastroenterologists, and 9 (16.7%) advanced endoscopists. One of the major study findings was that there was heterogeneity among participants' definition, evaluation, management, and follow‐up of DSs in PSC. The majority of participant responses were in accordance with societal practice guidelines, although considerable variation was noted. Conclusion: Despite the prevalence and morbidity of DSs in PSC, clinical perceptions and practices vary widely among hepatologists, gastroenterologists, and advanced endoscopists who manage these patients, even within a single health care system. Further studies are needed to address these variations, develop general and evidence‐based consensus, and increase adherence to societal guidelines. (Hepatology Communications 2018;2:836‐844)

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Section: Discussionmentioning

confidence: 99%

Dominant strictures in primary sclerosing cholangitis: A multicenter survey of clinical definitions and practices

Hilscher

Tabibian

Carey

et al. 2018

Hepatology Communications

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“…Specifically, the Amsterdam group aimed at inserting a single 10-Fr stent, and if this was not possible at first attempt, it was preceded by 1-week stenting with a 7-Fr stent or insertion of a nasobiliary catheter (55,61). The Mayo group used 7-10-Fr stents at the endoscopist's discretion (53).…”

Section: Stent Therapymentioning

confidence: 99%

“…All studies mentioned focused on clinical and serum liver tests, not radiological data, to assess the shortterm effect of therapeutic ERCP (53,55,61,62). Endoscopic treatment has been repeated in a sizeable proportion of patients: for example, with long median stenting periods (3 months), the median number of repeated ERCPs per patients ranged between 3 and 5 during follow-up periods of 29 and 22 months in two studies (53,62) while following a short stenting period (mean, 11 days) repeat ERCP rates at one and three years after treatment were estimated at 20% and 40%, respectively (55).…”

Section: Duration Of Stentingmentioning

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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“…Endoprostheses can be placed across strictures, but stent occlusion and cholangitis are frequent, and prospective studies failed to show their benefit. [131][132][133][134][135] Endoscopic dilation of dominant strictures is currently widely practiced despite the lack of prospective randomized controlled trials demonstrating its benefit. 136,137 Retrospective analyses using the Mayo Risk Score to model outcome, however, have suggested that endoscopic dilatation of dominant strictures does improve survival.…”

Section: Dr Marshall Kaplan (Tufts-new England Medicalmentioning

confidence: 99%

Primary sclerosing cholangitis: Summary of a workshop

et al. 2006

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Primary sclerosing cholangitis (PSC) is a rare but important liver disease that leads to cirrhosis and need for liver transplantation in a high proportion of cases. The disease occurs in approximately 1 per 100,000 population per year, usually presents in adulthood, and affects men more often than women. Typical serum biochemical results, autoantibodies and liver biopsy are suggestive but not diagnostic of PSC, the diagnosis requiring cholangiographic demonstration of stricturing and dilatation of the intra-and/or extra-hepatic bile ducts. The natural history of PSC is variable, the average survival being 12 to 17 years. The cause of PSC is still unknown. Although considered an autoimmune disease, PSC has several atypical features and a strong genetic component. The therapy of PSC is unsatisfactory. Standard doses of ursodeoxycholic acid (UDCA) lead to improvements in biochemical abnormalities but not in histology, cholangiographic appearance or survival. Several innovative therapies have been tried in PSC, but with scant evidence of benefit. For patients with high grade strictures, endoscopic dilatation is beneficial. Liver transplantation is successful for end-stage liver disease due to PSC and improves survival. PSC may recur after transplantation but is rarely progressive. The most dreaded complication of PSC is cholangiocarcinoma. Diagnosis of this highly malignant tumor is difficult, and there are no biomarkers for its early detection. Liver transplantation for cholangiocarcinoma has an exceedingly poor outcome, although transplantation with neoadjuvant chemoirradiation holds promise in selected patients. Thus, significant opportunities remain for basic and clinical research into the cause, natural history, and therapy of PSC. 44:746-764.)

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Lack of complications following short-term stent therapy for extrahepatic bile duct strictures in primary sclerosing cholangitis

Cited by 69 publications

References 11 publications

Dominant strictures in primary sclerosing cholangitis: A multicenter survey of clinical definitions and practices

Dominant strictures in primary sclerosing cholangitis: A multicenter survey of clinical definitions and practices

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: Summary of a workshop

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