Role of Endoscopy in Primary Sclerosing Cholangitis

Abstract

cholangitis (PSC) is a progressive disease of the bile ducts that usually results in chronic liver disease often requiring liver transplantation. Endoscopy remains crucial to the care of these patients, although magnetic resonance cholangiopancreatography has replaced endoscopic retrograde cholangiopancreatography (ERCP) as the primary imaging modality for diagnosis. For detection of dysplasia or cholangiocarcinoma, ERCP with intraductal sampling remains compulsory. Moreover, dominant strictures play an important part in the disease development, and management by balloon dilatation or stenting could contribute to long-term prognosis. In addition, endoscopy offers management for adverse events such as bile leaks and anastomotic strictures after liver transplantation. Finally, the special phenotype of inflammatory bowel disease associated with PSC as well as the frequent occurrence of portal hypertension mandates close follow-up with colonoscopy and upper endoscopy. With the emergence of novel techniques, the endoscopist remains a key member of the multidisciplinary team caring for PSC patients. Clin Endosc 2020 May 8.

Primary sclerosing cholangitis—A long night's journey into day

“…As noted above, operative correction of biliary obstruction has been all but abandoned 20 and supplanted by LT for advanced disease, intractable complications and even hilar CCA, 44,61 except perhaps for the occasional non‐cirrhotic in whom endoscopic therapy has failed 62 . Regarding endoscopic therapy of PSC, and particularly the dilatation of high‐grade strictures in symptomatic patients using bougies or balloon catheters, it is salutary to accept that these skillful manipulations, which have gratifying short‐term success, 63,64 have yet to be sanctioned by randomized controlled trials but, nonetheless, are recommended 59,65 in patients with, what are now termed, clinically relevant 66 strictures.…”

Cholangiocarcinoma: early detection and screening in high-risk population

“…Available guidelines recommend ERCP in symptomatic PSC patients with clinical symptoms, worsening cholestasis, weight loss, or a new or progressive DS [20,40,42,43] . These patients are candidates for a therapeutic ERCP with stricture dilatation and/or biliary stent depending on the DS characteristics and clinical specific indication.…”

Antibiotic prophylaxis and its effect on postprocedural adverse events in endoscopic retrograde cholangiopancreatography for primary sclerosing cholangitis

“…PSC is characterized by multiple biliary strictures, with a risk of developing liver cirrhosis and cholangiocarcinoma. Endoscopic retrograde cholangiopancreatography (ERCP) is the cornerstone in the diagnosis and treatment of PSC 2–5 . For patients with PSC, ERCP procedures are burdened with higher rates of adverse events than ERCP procedures for other indications 2,6–12 .…”

“…Endoscopic retrograde cholangiopancreatography (ERCP) is the cornerstone in the diagnosis and treatment of PSC. 2 , 3 , 4 , 5 For patients with PSC, ERCP procedures are burdened with higher rates of adverse events than ERCP procedures for other indications. 2 , 6 , 7 , 8 , 9 , 10 , 11 , 12 PSC, in particular, is shown to be an independent risk factor for post‐ERCP cholangitis (PEC).…”