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

  • Original Article—Liver, Pancreas, and Biliary Tract
  • Published:
Journal of Gastroenterology Aims and scope Submit manuscript

Abstract

Background

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.

Methods

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).

Results

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.

Conclusion

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.

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Abbreviations

ERCP:

Endoscopic retrograde cholangiopancreatography

PVCS:

Peroral video cholangioscopy

PSC:

Primary sclerosing cholangitis

IgG4-SC:

IgG4-related sclerosing cholangitis

HCCA:

Hilar cholangiocarcinoma

DCCA:

Distal cholangiocarcinoma

NBI:

Narrow-band imaging

WLI:

White light imaging

HPF:

High-power field

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Acknowledgments

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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Authors and Affiliations

  1. Department of Gastroenterology and Hepatology, Tokyo Medical University Hospital, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan

    Takao Itoi, Fumihide Itokawa & Fuminori Moriyasu

  2. Department of Internal Medicine, Tokyo Metropolitan Komagome Hospital, Tokyo, Japan

    Terumi Kamisawa & Seiichi Hara

  3. Toho University Omori Medical Center, Tokyo, Japan

    Yoshinori Igarashi & Yuui Kishimoto

  4. Department of Gastroenterology, Hokkaido University Graduate School of Medicine, Sapporo, Japan

    Hiroshi Kawakami & Masaki Kuwatani

  5. First Department of Internal Medicine, Gifu University Hospital, Gifu, Japan

    Ichiro Yasuda & Shinpei Doi

  6. Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA

    Todd H. Baron

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  1. Takao Itoi
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  2. Terumi Kamisawa
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  3. Yoshinori Igarashi
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Correspondence to Takao Itoi.

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Itoi, T., Kamisawa, T., Igarashi, Y. et al. The role of peroral video cholangioscopy in patients with IgG4-related sclerosing cholangitis. J Gastroenterol 48, 504–514 (2013). https://doi.org/10.1007/s00535-012-0652-6

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  • DOI: https://doi.org/10.1007/s00535-012-0652-6

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