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 language | English (US) |
|---|---|
| Pages (from-to) | 842-850 |
| Number of pages | 9 |
| Journal | Annals of Hepatology |
| Volume | 16 |
| Issue number | 6 |
| DOIs | |
| State | Published - Nov 1 2017 |
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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 journal › Review article
}
TY - JOUR
T1 - Endoscopic management of primary sclerosing cholangitis
AU - Barkin, Jodie A.
AU - Levy, Cynthia
AU - Souto, Enrico
PY - 2017/11/1
Y1 - 2017/11/1
N2 - 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.
AB - 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.
KW - Dominant stricture
KW - Endoscopic retrograde cholangiopancreatography
KW - Endoscopy
KW - Management
KW - Primary sclerosing cholangitis
UR - http://www.scopus.com/inward/record.url?scp=85031902523&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85031902523&partnerID=8YFLogxK
U2 - 10.5604/01.3001.0010.5274
DO - 10.5604/01.3001.0010.5274
M3 - Review article
C2 - 29055922
AN - SCOPUS:85031902523
VL - 16
SP - 842
EP - 850
JO - Annals of Hepatology
JF - Annals of Hepatology
SN - 1665-2681
IS - 6
ER -