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Endoscopic transpapillary intraductal ultrasonography and biopsy in the diagnosis of IgG4-related sclerosing cholangitis

  • Original Article—Liver, Pancreas, and Biliary Tract
  • Published:
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Abstract

Purpose

IgG4-related sclerosing cholangitis (IgG4-SC) is one of the diseases associated with autoimmune pancreatitis. Several cases of IgG4-SC showed no pancreas abnormalities and it was difficult to distinguish cholangiocarcinoma. We aimed to clarify the findings of transpapillary intraductal ultrasonography (IDUS) and bile duct biopsy in the patients with IgG4-SC.

Methods

We retrospectively evaluated the findings of transpapillary IDUS and biopsy in 23 consecutive patients with IgG4-SC at Nagoya City University Hospital between 2004 and 2008. Eleven patients with cholangiocarcinoma were enrolled as a control group.

Results

IDUS findings of circular-symmetric wall thickness, a smooth outer margin, a smooth inner margin and a homogeneous internal echo in the stricture were significantly higher in IgG4-SC than in cholangiocarcinoma (p < 0.01). The wall thickness in IgG4-SC in regions of non-stricture on the cholangiogram was significantly greater than that in cholangiocarcinoma (p < 0.0001). A bile duct wall thickness exceeding 0.8 mm in regions of non-stricture on the cholangiogram was highly suggestive of IgG4-SC (sensitivity 95.0%, specificity 90.9%, accuracy 93.5%). In transpapillary biopsy, lymphoplasmacytic infiltration was observed in 100% (17/17), fibrosis in 82% (14/17), and obliterative phlebitis in 0%. The abundant IgG4-positive plasma cells were observed in 18% (3/17).

Conclusions

The IDUS findings were useful for distinction of IgG4-SC from cholangiocarcinoma. Transpapillary biopsy was not useful for direct diagnosis of IgG4-SC even after IgG4 immunostaining, but it did allow distinction of IgG4-SC from cholangiocarcinoma in some cases. IDUS and transpapillary biopsy after endoscopic retrograde cholangiopancreatography can provide further information for precise diagnosis of IgG4-SC.

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Acknowledgments

This study was supported by the Pancreas Research Foundation of Japan and by Health and Labor Sciences research grants (Research on Specific Diseases, Intractable Diseases of the Pancreas, Ministry of Health Labor and Welfare, Japan).

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Authors and Affiliations

  1. Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi Mizuho-cho, Mizuho-ku, Nagoya, 467-8601, Japan

    Itaru Naitoh, Takahiro Nakazawa, Hirotaka Ohara, Tomoaki Ando, Kazuki Hayashi, Hajime Tanaka, Fumihiro Okumura & Takashi Joh

  2. Department of Experimental Pathology and Tumor Biology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan

    Satoru Takahashi

Authors
  1. Itaru Naitoh
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  2. Takahiro Nakazawa
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  3. Hirotaka Ohara
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  4. Tomoaki Ando
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  5. Kazuki Hayashi
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  6. Hajime Tanaka
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  7. Fumihiro Okumura
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  8. Satoru Takahashi
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  9. Takashi Joh
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Corresponding author

Correspondence to Takahiro Nakazawa.

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Naitoh, I., Nakazawa, T., Ohara, H. et al. Endoscopic transpapillary intraductal ultrasonography and biopsy in the diagnosis of IgG4-related sclerosing cholangitis. J Gastroenterol 44, 1147–1155 (2009). https://doi.org/10.1007/s00535-009-0108-9

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  • DOI: https://doi.org/10.1007/s00535-009-0108-9

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