Predictors of Successful Clinical and Laboratory Outcomes in Patients with Primary Sclerosing Cholangitis Undergoing Endoscopic Retrograde Cholangiopancreatography

Abstract

First, in PSC, clinical and laboratory improvement is more common in patients undergoing therapeutic ERCP than diagnostic ERCP. Second, aspartate aminotransferase, alanine aminotransferase and alkaline phosphatase improve following both diagnostic and therapeutic ERCP, and should therefore not be relied upon to determine the success of the procedure. Third, bilirubin levels decreased in the therapeutic group but remained unchanged in the diagnostic group, suggesting that the serum bilirubin level may be a more sensitive indicator of successful therapeutic intervention than transaminases. Fourth, common bile duct strictures, dominant strictures and bilirubin levels are important variables in determining the success of an ERCP in PSC. Finally, complication rates after therapeutic ERCP are similar to those after diagnostic ERCP in PSC patients. However, severe complications occur more commonly in the therapeutic group.

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

“…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).…”

Comorbidities, Sphincterotomy, and Balloon Dilation Predict Post-ERCP Adverse Events in PSC Patients: Operator Experience Is Protective

“…PSC is characterized by inflammation and fibrosis of the intrahepatic and extrahepatic bile ducts. The disease is highly variable in its progression, but can eventually lead to cirrhosis and other adverse events including portal hypertension, cholestasis and jaundice, recurrent ascending cholangitis, and cholangiocarcinoma [1][2][3]. The incidence of PSC is approximately 100 per million/year in the United States, with a 10-year survival after diagnosis of approximately 65% [2].…”

The best approach for diagnosing primary sclerosing cholangitis

“…Some studies have shown that ERCP may be dangerous for patients with PSC 9,10. In patients with PSC, liver function may be impaired after ERCP.…”