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

Aabakken, Lars; Karlsen, Tom H.; Albert, Jörg; Arvanitakis, Marianna; Chazouillères, Olivier; Dumonceau, Jean‐Marc; Färkkilä, Martti; Fickert, Peter; Hirschfield, Gideon M.; Laghi, Andréa; Marzioni, Marco; Fernandez, Michaël; Pereira, Stephen P.; Pohl, Jürgen; Poley, Jan–Werner; Ponsioen, Cyriel Y.; Schramm, Christoph; Swahn, Fredrik; Tringali, Andrea; Hassan, Cesare

doi:10.1016/j.jhep.2017.02.013

Cited by 88 publications

(65 citation statements)

References 124 publications

(135 reference statements)

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“…Both AASLD and EASL guidelines therefore recommend periprocedural antibiotics in the setting of endoscopic dilatation with or without stent placement 15. Optimal antibiotic choice and duration of treatment are not specified in the guidelines, and the present study reveals heterogeneity in practice.…”

Section: Discussionmentioning

confidence: 83%

“…Both AASLD and EASL guidelines define a DS as a “stenosis <1.5 mm in diameter in the common bile duct and <1 mm in the right and left hepatic ducts.”10, 11, 15 While most participants agreed with these diameter cutoffs, nearly 48% did not deem them necessary to consider a biliary stenosis a DS and instead placed emphasis on other factors (e.g., upstream ductal dilation).…”

Section: Resultsmentioning

confidence: 99%

“…Indeed, a study by Baluyut et al18 of 63 asymptomatic and symptomatic patients with PSC and a DS who underwent endoscopic therapy with balloon dilatation revealed improved 5‐year survival as estimated by the Mayo Risk Score; this study and others18, 27 suggest that endoscopic intervention for DSs may confer a sustained benefit and potentially alter the natural history of PSC. As such, there is general recommendation that endoscopic intervention be undertaken in patients with a DS in the presence of worrisome signs or symptoms, such as cholangitis, new or worsening pruritus, jaundice, right upper quadrant pain, or cholestatic laboratory profile 15, 25, 26, 28. The role of endoscopic intervention for asymptomatic DSs (i.e., in the absence of related signs or symptoms) is less clear, although it is not uncommon to see patients undergo multiple ERCs in this clinical scenario.…”

Section: Discussionmentioning

confidence: 99%

“…Conversely, individual tests generally have suboptimal performance characteristics. For example, conventional brush cytology has excellent specificity (nearly 100%) but limited sensitivity (ranging from 18%‐40%) in diagnosing CCA 15, 35, 36, 37, 38, 39. Similarly, while serum CA 19‐9 has a reported sensitivity and specificity of 79% and 98%, respectively, at a cut‐off value of 130 U/mL,40 its levels may become elevated in the setting of nonmalignant obstruction or acute cholangitis, and it is undetectable in Lewis blood antigen‐negative patients (and remains so even in the presence of CCA) 41.…”

Section: Discussionmentioning

confidence: 99%

“…Similarly, while serum CA 19‐9 has a reported sensitivity and specificity of 79% and 98%, respectively, at a cut‐off value of 130 U/mL,40 its levels may become elevated in the setting of nonmalignant obstruction or acute cholangitis, and it is undetectable in Lewis blood antigen‐negative patients (and remains so even in the presence of CCA) 41. Based on the aforementioned, both AASLD and EASL guidelines recommend obtaining endoscopic biliary brushings if CCA is suspected in patients with PSC 15. In addition, EASL guidelines recommend supplementing biliary brushings with serum CA 19‐9 and FISH analysis (where available) given their ancillary value 42.…”

Section: Discussionmentioning

confidence: 99%

See 4 more Smart Citations

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: 83%