Endoscopic management of primary sclerosing cholangitis

Jodie A. Barkin, Cynthia Levy, Enrico Souto

Research output: Contribution to journalReview article

8 Citations (Scopus)

Abstract

Primary sclerosing cholangitis (PSC) remains a rare but potentially devastating chronic, cholestatic liver disease. PSC causes obstruction of intra- and/or extra-hepatic bile ducts by inflammation and fibrosis, leading to biliary obstruction, cirrhosis and portal hypertension with all associated sequelae. The most dreaded consequence of PSC is cholangiocarcinoma, occurring in 10-20% of patients with PSC, and with population-based estimates of a 398-fold increased risk of cholangiocarcinoma in patients with PSC compared to the general population. We use the 4-D approach to endoscopic evaluation and management of PSC based on currently available evidence. After laboratory testing with liver chemistries and high-quality cross-sectional imaging with MRCP, the first D is Dominant stricture diagnosis and evaluation. Second, Dilation of strictures found during ERCP is performed using balloon dilation to as many segments as possible. Third, Dysplasia and cholangiocarcinoma diagnosis is performed by separated brushings for conventional cytology and fluorescence in situ hybridization (FISH), and consideration for direct cholangioscopy with SpyGlass™. Fourth and finally, Dosing of antibiotics is critical to prevent peri-procedural cholangitis. The aim of this review article is to explore endoscopic tools and techniques for the diagnosis and management of PSC and provide a practical approach for clinicians.

Original languageEnglish (US)
Pages (from-to)842-850
Number of pages9
JournalAnnals of Hepatology
Volume16
Issue number6
DOIs
StatePublished - Nov 1 2017

Fingerprint

Sclerosing Cholangitis
Cholangiocarcinoma
Dilatation
Pathologic Constriction
Common Hepatic Duct
Cholangitis
Biliary Liver Cirrhosis
Endoscopic Retrograde Cholangiopancreatography
Portal Hypertension
Bile Ducts
Fluorescence In Situ Hybridization
Population
Cell Biology
Liver Diseases
Fibrosis
Anti-Bacterial Agents
Inflammation
Liver

Keywords

  • Dominant stricture
  • Endoscopic retrograde cholangiopancreatography
  • Endoscopy
  • Management
  • Primary sclerosing cholangitis

ASJC Scopus subject areas

  • Hepatology

Cite this

Endoscopic management of primary sclerosing cholangitis. / Barkin, Jodie A.; Levy, Cynthia; Souto, Enrico.

In: Annals of Hepatology, Vol. 16, No. 6, 01.11.2017, p. 842-850.

Research output: Contribution to journalReview article

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