Journal of Gastroenterology

, Volume 48, Issue 4, pp 504–514 | Cite as

The role of peroral video cholangioscopy in patients with IgG4-related sclerosing cholangitis

  • Takao ItoiEmail author
  • Terumi Kamisawa
  • Yoshinori Igarashi
  • Hiroshi Kawakami
  • Ichiro Yasuda
  • Fumihide Itokawa
  • Yuui Kishimoto
  • Masaki Kuwatani
  • Shinpei Doi
  • Seiichi Hara
  • Fuminori Moriyasu
  • Todd H. Baron
Original Article—Liver, Pancreas, and Biliary Tract



The cholangioscopic features of IgG4-related sclerosing cholangitis (IgG4-SC) remain undefined. The aim of this study was to clarify these endoscopic features using peroral video cholangioscopy (PVCS) in IgG4-SC patients.


PVCS was performed in 33 patients: IgG4-SC (n = 13); primary sclerosing cholangitis (PSC; n = 5); and cholangiocarcinoma (n = 15), which included hilar cholangiocarcinoma (HCCA; n = 5) and distal cholangiocarcinoma (DCCA; n = 10).


The most frequent findings on PVCS in the IgG4-SC patients were dilated (62 %) and tortuous (69 %) vessels, and absence of partially enlarged vessels. The incidence of dilated and tortuous vessels was significantly higher in IgG4-SC patients than in PSC patients (p = 0.015). Scarring and pseudodiverticula were found significantly more often in PSC patients than in IgG4-SC patients (p = 0.001 and p = 0.0007, respectively). The incidence of partially enlarged vessels was significantly higher in DCCA patients than in IgG4-SC patients (p = 0.004). In contrast, the incidence of dilated vessels was significantly higher in IgG4-SC patients than in HCCA patients (p = 0.015). PVCS performed after corticosteroid therapy showed resolution of bile duct stenosis and dilated, tortuous, or partially enlarged vessels, as well as resolution of friability in all patients with IgG4-SC.


Cholangioscopy was useful in differentiating IgG4-SC from PSC. In addition, monitoring the patterns of proliferative vessels on PVCS may be useful to differentiate IgG4-SC from cholangiocarcinoma.


Endoscopic retrograde cholangiopancreatography Peroral cholangioscopy Bile duct diseases 



Endoscopic retrograde cholangiopancreatography


Peroral video cholangioscopy


Primary sclerosing cholangitis


IgG4-related sclerosing cholangitis


Hilar cholangiocarcinoma


Distal cholangiocarcinoma


Narrow-band imaging


White light imaging


High-power field



The authors are indebted to Mr. Roderick J. Turner, Associate Professor Edward F. Barroga, and Professor J. Patrick Barron, Chairman of the Department of International Medical Communications of Tokyo Medical University, for their editorial review of this manuscript. We are also very grateful to Dr. Satoshi Morita of the Department of Biostatistics and Epidemiology, Yokohama City University Graduate School of Medicine and University Medical Center, for his advice regarding statistical analysis. This work was supported in part by the Research Committee of Intractable Pancreatic Diseases (Principal investigator: Tooru Shimosegawa) provided by the Ministry of Health, Labour, and Welfare of Japan.

Conflict of interest

The following author discloses financial relationships relevant to this publication: Dr. Takao Itoi gives lectures and consults for Olympus Medical Systems. The other authors declare that they have no financial relationships relevant to this publication.


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Copyright information

© Springer 2012

Authors and Affiliations

  • Takao Itoi
    • 1
    Email author
  • Terumi Kamisawa
    • 2
  • Yoshinori Igarashi
    • 3
  • Hiroshi Kawakami
    • 4
  • Ichiro Yasuda
    • 5
  • Fumihide Itokawa
    • 1
  • Yuui Kishimoto
    • 3
  • Masaki Kuwatani
    • 4
  • Shinpei Doi
    • 5
  • Seiichi Hara
    • 2
  • Fuminori Moriyasu
    • 1
  • Todd H. Baron
    • 6
  1. 1.Department of Gastroenterology and HepatologyTokyo Medical University HospitalTokyoJapan
  2. 2.Department of Internal MedicineTokyo Metropolitan Komagome HospitalTokyoJapan
  3. 3.Toho University Omori Medical CenterTokyoJapan
  4. 4.Department of GastroenterologyHokkaido University Graduate School of MedicineSapporoJapan
  5. 5.First Department of Internal MedicineGifu University HospitalGifuJapan
  6. 6.Division of Gastroenterology and HepatologyMayo ClinicRochesterUSA

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