The role of peroral video cholangioscopy in patients with IgG4-related sclerosing cholangitis
- 543 Downloads
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.
KeywordsEndoscopic retrograde cholangiopancreatography Peroral cholangioscopy Bile duct diseases
Endoscopic retrograde cholangiopancreatography
Peroral video cholangioscopy
Primary sclerosing cholangitis
IgG4-related sclerosing cholangitis
White light imaging
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.
- 3.The Research Committee of IgG4-related Diseases provided by the Ministry of Health, Labor and Welfare of Japan: The Research Committee of Intractable Diseases of Liver and Biliary Tract provided by the Ministry of Health, Labor and Welfare of Japan: The Japan Biliary Association. Clinical diagnostic criteria of IgG4-related sclerosing cholangitis 2012 (Japanese with English abstract). J Jpn Bil Assoc. 2012;26:59–63.Google Scholar
- 4.Zen Y, Harada K, Sasaki M, Sato Y, Tsuneyama K, Haratake J. IgG4-related sclerosing cholangitis with and without hepatic inflammatory pseudotumor, and sclerosing pancreatitis-associated sclerosing cholangitis: do they belong to a spectrum of sclerosing pancreatitis? Am J Surg Pathol. 2004;28:1193–203.PubMedCrossRefGoogle Scholar
- 13.Nakajima M, Akasaka Y, Fukumoto K, et al. Peroral cholangiopancreatoscopy (PCPS) under duodenoscopic guidance. Am J Gastroenterol. 1978;66:241–7.Google Scholar
- 14.Kozarek R. Direct cholangioscopy and pancreatoscopy at time of endoscopic retrograde cholangiopancreatography. Am J Gastroentrol. 1988;83:55–7.Google Scholar
- 30.Kasuya K, Watanabe H, Itoi T, et al. Histological grading of malignancy of extrahepatic bile duct carcinomas (Japanese with English abstract). Stomach Intestine. 1994;29:751–9.Google Scholar