Tissue Acquisition for Histologic Diagnosis

  • Ji Kon RyuEmail author


IgG4-SC is a characteristic type of sclerosing cholangitis with increased serum IgG4 levels and dense infiltration of IgG4-positive plasma cells with extensive fibrosis in the bile duct wall. Histopathologic examination is always necessary for the definite diagnosis of IgG4-SC if there are no other organ involvements such as type 1 AIP, IgG4-related sialadenits or retroperitoneal fibrosis. Endobiliary biopsy by ERC is a standard technique for tissue acquisition of bile duct. However, it is not easy to obtain sufficient bile duct tissue to study the characteristic histology of IgG4-SC biopsy specimens because fibroinflammatory involvement is observed mainly in the submucosa of the bile duct wall, whereas the epithelium of the bile duct is sometimes intact. Liver biopsy can be useful and diagnostic if IgG4-SC involve intrahepatic small bile duct and be considered as a last tissue acquisition method if endobiliary biopsy is nondiagnostic.


  1. 1.
    Deshpande V, Zen Y, Chan JK, et al. Consensus statement on the pathology of IgG4-related disease. Mod Pathol. 2012;25:1181–92.CrossRefPubMedGoogle Scholar
  2. 2.
    Alswat K, Al-Harthy N, Mazrani W, Alshumrani G, Jhaveri K, Hirschfield GM. The spectrum of sclerosing cholangitis and the relevance of IgG4 elevations in routine practice. Am J Gastroenterol. 2012;107:56–63.CrossRefPubMedGoogle Scholar
  3. 3.
    Ghazale A, Chari ST, Zhang L, Smyrk TC, Takahashi N, Levy MJ, et al. Immunoglobulin G4-associated cholangitis: clinical profile and response to therapy. Gastroenterology. 2008;134:706–15.CrossRefPubMedGoogle Scholar
  4. 4.
    Ohara H, Okazaki K, Tsubouchi H, Inui K, Kawa S, Kamisawa T, et al. Clinical diagnostic criteria of IgG4-related sclerosing cholangitis 2012. J Hepatobiliary Pancreat Sci. 2012;19:536–42.CrossRefPubMedGoogle Scholar
  5. 5.
    Nakazawa T, Ohara H, Sano H, Ando T, Joh T. Schematic classification of sclerosing cholangitis with autoimmune pancreatitis by cholangiography. Pancreas. 2006;32:229.CrossRefPubMedGoogle Scholar
  6. 6.
    Rustgi AK, Kelsey PB, Guelrud M, et al. Malignant tumors of the bile ducts: diagnosis by biopsy during endoscopic cannulation. Gastrointest Endosc. 1989;35(3):248–51.CrossRefPubMedGoogle Scholar
  7. 7.
    Schoefl R, Haefner M, Wrba F. Forceps biopsy and brush cytology during endoscopic retrograde cholangiopancreatography for the diagnosis of biliary stenoses. Scand J Gastroenterol. 1997;32:363–8.CrossRefPubMedGoogle Scholar
  8. 8.
    Korc P, Sherman S. ERCP tissue sampling. Gastrointest Endosc. 2016;84:557–71.CrossRefPubMedGoogle Scholar
  9. 9.
    Nakanuma Y, Zen Y. Pathology and immunopathology of immunoglobulin G4-related sclerosing cholangitis: the latest addition to the sclerosing cholangitis family. Hepatol Res. 2007;37(Suppl 3):S478–86.CrossRefPubMedGoogle Scholar
  10. 10.
    Kawakami H, Kuwatani M, Etoh K, et al. Endoscopic retrograde cholangiography versus peroral cholangioscopy to evaluate intraepithelial tumor spread in biliary cancer. Endoscopy. 2009;41:959–64.CrossRefPubMedGoogle Scholar
  11. 11.
    Itoi T, Osanai M, Igarashi Y, et al. Diagnostic peroral video cholangioscopy is an accurate diagnostic tool for patients with bile duct lesions. Clin Gastroenterol Hepatol. 2010;8:934–8.CrossRefPubMedGoogle Scholar
  12. 12.
    Navaneethan U, Hasan MK, Lourdusamy V. Single-operator cholangioscopy and targeted biopsies in the diagnosis of indeterminate biliary strictures: a systematic review. Gastrointest Endosc. 2015;82:608–14.CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Springer Science+Business Media Singapore 2019

Authors and Affiliations

  1. 1.Division of Gastroenterology, Department of Internal MedicineSeoul National University College of MedicineSeoulSouth Korea

Personalised recommendations