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Biliary inflammation scoring for immunoglobulin G4-related sclerosing cholangitis: an endoscopic approach with endoscopic ultrasound

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Abstract

Background and Aims

The differential diagnosis of immunoglobulin G4-related sclerosing cholangitis (IgG4-SC) and cholangiocarcinoma (CC) remains a clinical challenge. Imaging modalities play critical roles in the diagnosis of IgG4-SC. The present study aimed to evaluate the differential diagnosis of IgG4-SC and CC based on images of endoscopic ultrasound (EUS).

Methods

The biliary inflammation scoring (BIS) method for EUS was developed based on the comparison between images of IgG4-SC and that of cholangiocarcinoma (CC) and other acute or chronic cholangitis. In the BIS diagnostic phase, the EUS images from 66 IgG4-SC patients and 44 CC patients were blindly evaluated using the BIS methods.

Results

The sensitivity, specificity, and accuracy of the newly established BIS in distinguishing IgG4-SC from CC were 86% [95% confidence interval (CI) 75–93%], 95% (95% CI 83–99%), and 90% (95% CI 83–94%), respectively.

Conclusion

EUS should be considered to be added to the workup algorithm in patients with suspected IgG4-SC as a useful diagnostic procedure. BIS is a promising diagnostic method to discriminate IgG4-SC during the ongoing endoscopy.

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Abbreviations

IgG4-SC:

Immunoglobulin G4-related sclerosing cholangitis

IgG4-RD:

Immunoglobulin G4-related disease

CC:

Cholangiocarcinoma

CT:

Computed tomography

MR:

Magnetic resonance

ERC:

Endoscopic retrograde cholangiography

IDUS:

Intraductal ultrasonography

EUS:

Endoscopic ultrasound

AIP:

Autoimmune pancreatitis

BIS:

Biliary inflammation scoring

ICDC:

International Consensus Diagnostic Criteria

FNA:

Fine needle aspiration

PPV:

Positive predictive value

NPV:

Negative predictive value

ROC curve:

Receiver-operating characteristic curve

CI:

Confidential interval

MRCP:

Magnetic resonance cholangiopancreatography

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Funding

Supported by the Fundamental Research Funds for the Central Universities (3332019033).

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Author notes

  1. Yunlu Feng and Shengyu Zhang have contributed equally to this work.

Authors and Affiliations

  1. Department of Gastroenterology, Peking Union Medical College Hospital, 1 Shuaifuyuan, Wangfujing Avenue, Beijing, 100730, China

    Yunlu Feng, Shengyu Zhang, Zehui Zheng, Xi Wu, Tao Guo, Qingwei Jiang, Qiang Wang, Dongsheng Wu & Aiming Yang

Authors
  1. Yunlu Feng
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  2. Shengyu Zhang
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  3. Zehui Zheng
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  4. Xi Wu
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  5. Tao Guo
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  6. Qingwei Jiang
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  7. Qiang Wang
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  8. Dongsheng Wu
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  9. Aiming Yang
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Contributions

Study concept and design, and paper preparation—YLF and AMY. Paper preparation and Statistical analysis—YLF and SYZ. Paper preparation and critical revisions—ZHZ, TG, XW, QWJ, QW and DSW.

Corresponding author

Correspondence to Aiming Yang.

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Disclosures

Drs. Yunlu Feng, Shengyu Zhang, Zehui Zheng, Xi Wu, Tao Guo, Qingwei Jiang, Qiang Wang and Dongsheng Wu and Aiming Yang have no conflicts of interest or financial ties to disclose.

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Feng, Y., Zhang, S., Zheng, Z. et al. Biliary inflammation scoring for immunoglobulin G4-related sclerosing cholangitis: an endoscopic approach with endoscopic ultrasound. Surg Endosc 35, 7068–7073 (2021). https://doi.org/10.1007/s00464-020-08222-y

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  • DOI: https://doi.org/10.1007/s00464-020-08222-y

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