medigraphic.com
Órgano Oficial de la Asociación Mexicana de Hepatología

2017, Number 6

<< Back Next >>

Ann Hepatol 2017; 16 (6)

Endoscopic Management of Primary Sclerosing Cholangitis

Barkin JA, Levy C, Souto EO

Language: English
References: 72
Page: 842-850
PDF size: 258.09 Kb.


ABSTRACT

Primary sclerosing cholangitis (PSC) remains a rare but potentially devastating chronic, cholestatic liver disease. PSC causes obstruction of intra- and/or extra-hepatic bile ducts by inflammation and fibrosis, leading to biliary obstruction, cirrhosis and portal hypertension with all associated sequelae. The most dreaded consequence of PSC is cholangiocarcinoma, occurring in 10-20% of patients with PSC, and with population-based estimates of a 398-fold increased risk of cholangiocarcinoma in patients with PSC compared to the general population. We use the 4-D approach to endoscopic evaluation and management of PSC based on currently available evidence. After laboratory testing with liver chemistries and high-quality cross-sectional imaging with MRCP, the first D is Dominant stricture diagnosis and evaluation. Second, Dilation of strictures found during ERCP is performed using balloon dilation to as many segments as possible. Third, Dysplasia and cholangiocarcinoma diagnosis is performed by separated brushings for conventional cytology and fluorescence in situ hybridization (FISH), and consideration for direct cholangioscopy with SpyGlass™. Fourth and finally, Dosing of antibiotics is critical to prevent peri-procedural cholangitis. The aim of this review article is to explore endoscopic tools and techniques for the diagnosis and management of PSC and provide a practical approach for clinicians.


REFERENCES

  1. Wiesner RH, LaRusso NF. Clinicopathologic features of the syndrome of primary sclerosing cholangitis. Gastroenterology 1980; 79: 200-6.

  2. Sclair SN, Little E, Levy C. Current Concepts in Primary Biliary Cirrhosis and Primary Sclerosing Cholangitis. Clin Transl Gastroenterol 2015; 6: e109.

  3. Hirschfield GM, Karlsen TH, Lindor KD, Adams DH. Primary sclerosing cholangitis. Lancet 2013; 382: 1587-99.

  4. Maggs JR, Chapman RW. An update on primary sclerosing cholangitis. Curr Opin Gastroenterol 2008; 24: 377-83.

  5. Boonstra K, van Erpecum KJ, van Nieuwkerk KM, Drenth JP, Poen AC, Witteman BJ, Tuynman HA, et al. Primary sclerosing cholangitis is associated with a distinct phenotype of inflammatory bowel disease. Inflamm Bowel Dis 2012; 18: 2270-6.

  6. Olsson R, Danielsson A, Järnerot G, Lindström E, Lööf L, Rolny P, Rydén BO, et al. Prevalence of primary sclerosing cholangitis in patients with ulcerative colitis. Gastroenterology 1991; 199: 1319-23.

  7. Boonstra K, Weersma RK, van Erpecum KJ, Rauws EA, Spanier BW, Poen AC, van Nieuwkerk KM, et al. Populationbased epidemiology, malignancy risk, and outcome of primary sclerosing cholangitis. Hepatology 2013; 58: 2045-55.

  8. Horsley-Silva JL, Rodríguez EA, Franco DL, Lindor KD. An update on cancer risk and surveillance in primary sclerosing cholangitis. Liver Int 2017; 37: 1103-9.

  9. Fevery J, Verslype C, Lai G, Aerts R, Van Steenbergen W. Incidence, diagnosis, and therapy of cholangiocarcinoma in patients with primary sclerosing cholangitis. Dig Dis Sci 2007; 52: 3123-35.

  10. Weismüller TJ, Trivedi PJ, Bergquist A, Imam M, Lenzen H, Ponsioen CY, et al. Patient Age, Sex, and Inflammatory Bowel Disease Phenotype Associate With Course of Primary Sclerosing Cholangitis. Gastroenterology 2017; 152: 1975- 84.e8.

  11. Lindor KD, Kowdley KV, Harrison ME; American College of Gastroenterology. ACG Clinical Guideline: Primary Sclerosing Cholangitis. Am J Gastroenterol 2015; 110: 646-59.

  12. Aabakken L, Karlsen TH, Albert J, Arvanitakis M, Chazouilleres O, Dumonceau JM, Färkkilä M, et al. Role of endoscopy in primary sclerosing cholangitis: European Society of Gastrointestinal Endoscopy (ESGE) and European Association for the Study of the Liver (EASL) Clinical Guideline. Endoscopy 2017; 49: 588-608.

  13. Chapman R, Fevery J, Kalloo A, Nagorney DM, Boberg KM, Shneider B, Gores GJ, et al. Diagnosis and management of primary sclerosing cholangitis. Hepatology 2010; 51: 660-78.

  14. Angulo P, Pearce DH, Johnson CD, Henry JJ, LaRusso NF, Petersen BT, Lindor KD. Magnetic resonance cholangiography in patients with biliary disease: its role in primary sclerosing cholangitis. J Hepatol 2000; 33: 520-7.

  15. Berstad AE, Aabakken L, Smith HJ, Aasen S, Boberg KM, Schrumpf E. Diagnostic accuracy of magnetic resonance and endoscopic retrograde cholangiography in primary sclerosing cholangitis. Clin Gastroenterol Hepatol 2006; 4: 514- 20.

  16. Schramm C, Eaton J, Ringe KI, Venkatesh S, Yamamura J; MRI working group of the IPSCSG. Recommendations on the use of MRI in PSC-A position statement from the International PSC study group. Hepatology 2017 [Epub ahead of print].

  17. Dave M, Elmunzer BJ, Dwamena BA, Higgins PD. Primary sclerosing cholangitis: meta-analysis of diagnostic performance of MR cholangiopancreatography. Radiology 2010; 256: 387-96.

  18. Meagher S, Yusoff I, Kennedy W, Martel M, Adam V, Barkun A. The roles of magnetic resonance and endoscopic retrograde cholangiopancreatography (MRCP and ERCP) in the diagnosis of patients with suspected sclerosing cholangitis: a cost-effectiveness analysis. Endoscopy 2007; 39: 222-8.

  19. Stiehl A, Rudolph G, Klöters-Plachky P, Sauer P, Walker S. Development of dominant bile duct stenoses in patients with primary sclerosing cholangitis treated with ursodeoxycholic acid: outcome after endoscopic treatment. J Hepatol 2002; 36: 151-6.

  20. Tischendorf JJ, Hecker H, Krüger M, Manns MP, Meier PN. Characterization, outcome, and prognosis in 273 patients with primary sclerosing cholangitis: A single center study. Am J Gastroenterol 2007; 102: 107-14.

  21. Okolicsanyi L, Fabris L, Viaggi S, Carulli N, Podda M, Ricci G. Primary sclerosing cholangitis: clinical presentation, natural history and prognostic variables: an Italian multicentre study. The Italian PSC Study Group. Eur J Gastroenterol Hepatol 1996; 8: 685-91.

  22. Chapman MH, Webster GJ, Bannoo S, Johnson GJ, Wittmann J, Pereira SP. Cholangiocarcinoma and dominant strictures in patients with primary sclerosing cholangitis: a 25-year single- centre experience. Eur J Gastroenterol Hepatol 2012; 24: 1051-8.

  23. Kaplan GG, Laupland KB, Butzner D, Urbanski SJ, Lee SS. The burden of large and small duct primary sclerosing cholangitis in adults and children: a population-based analysis. Am J Gastroenterol 2007; 102: 1042-9.

  24. Stiehl A. Primary sclerosing cholangitis: the role of endoscopic therapy. Semin Liver Dis 2006; 26: 62-8.

  25. Johnson GK, Saeian K, Geenen JE. Primary sclerosing cholangitis treated by endoscopic biliary dilation: review and long-term follow-up evaluation. Curr Gastroenterol Rep 2006; 8: 147-55.

  26. Charatcharoenwitthaya P, Enders FB, Halling KC, Lindor KD. Utility of serum tumor markers, imaging, and biliary cytology for detecting cholangiocarcinoma in primary sclerosing cholangitis. Hepatology 2008; 48: 1106-17.

  27. Boyd S, Tenca A, Jokelainen K, Mustonen H, Krogerus L, Arola J, Färkkilä MA. Screening primary sclerosing cholangitis and biliary dysplasia with endoscopic retrograde cholangiography and brush cytology: risk factors for biliary neoplasia. Endoscopy 2016; 48: 432-9.

  28. Venkatesh PG, Navaneethan U, Shen B, McCullough AJ. Increased serum levels of carbohydrate antigen 19-9 and outcomes in primary sclerosing cholangitis patients without cholangiocarcinoma. Dig Dis Sci 2013; 58: 850-7.

  29. Trikudanathan G, Navaneethan U, Njei B, Vargo JJ, Parsi MA. Diagnostic yield of bile duct brushings for cholangiocarcinoma in primary sclerosing cholangitis: a systematic review and meta-analysis. Gastrointest Endosc 2014; 79: 783-9.

  30. Sangfelt P, Sundin A, Wanders A, Rasmussen I, Karlson BM, Bergquist A, Rorsman F. Monitoring dominant strictures in primary sclerosing cholangitis with brush cytology and FDGPET. J Hepatol 2014; 61: 1352-7.

  31. Levy MJ, Baron TH, Clayton AC, Enders FB, Gostout CJ, Halling KC, Kipp BR, et al. Prospective evaluation of advanced molecular markers and imaging techniques in patients with indeterminate bile duct strictures. Am J Gastroenterol 2008; 103: 1263-73.

  32. Bangarulingam SY, Bjornsson E, Enders F, Barr Fritcher EG, Gores G, Halling KC, Lindor KD. Long-term outcomes of positive fluorescence in situ hybridization tests in primary sclerosing cholangitis. Hepatology 2010; 51: 174-80.

  33. Quinn KP, Tabibian JH, Lindor KD. Clinical implications of serial versus isolated biliary fluorescence in situ hybridization (FISH) polysomy in primary sclerosing cholangitis. Scand J Gastroenterol 2017; 52: 377-81.

  34. Barr Fritcher EG, Kipp BR, Voss JS, Clayton AC, Lindor KD, Halling KC, Gores GJ. Primary sclerosing cholangitis patients with serial polysomy fluorescence in situ hybridization results are at increased risk of cholangiocarcinoma. Am J Gastroenterol 2011; 106: 2023-8.

  35. Nanda A, Brown JM, Berger SH, Lewis MM, Barr Fritcher EG, Gores GJ, Keilin SA, et al. Triple modality testing by endoscopic retrograde cholangiopancreatography for the diagnosis of cholangiocarcinoma. Therap Adv Gastroenterol 2015; 8: 56-65.

  36. Awadallah NS, Chen YK, Piraka C, Antillon MR, Shah RJ. Is there a role for cholangioscopy in patients with primary sclerosing cholangitis? Am J Gastroenterol 2006; 101: 284- 91.

  37. Kawakami H, Kuwatani M, Etoh K, Haba S, Yamato H, Shinada K, Nakanishi Y, et al. Endoscopic retrograde cholangiography versus peroral cholangioscopy to evaluate intraepithelial tumor spread in biliary cancer. Endoscopy 2009; 41: 959-64.

  38. Nishikawa T, Tsuyuguchi T, Sakai Y, Sugiyama H, Miyazaki M, Yokosuka O. Comparison of the diagnostic accuracy of peroral video-cholangioscopic visual findings and cholangioscopy- guided forceps biopsy findings for indeterminate biliary lesions: a prospective study. Gastrointest Endosc 2013; 77: 219-26.

  39. Kurihara T, Yasuda I, Isayama H, Tsuyuguchi T, Yamaguchi T, Kawabe K, Okabe Y, et al. Diagnostic and therapeutic singleoperator cholangiopancreatoscopy in biliopancreatic diseases: Prospective multicenter study in Japan. World J Gastroenterol 2016; 22: 1891-901.

  40. Arnelo U, von Seth E, Bergquist A. Prospective evaluation of the clinical utility of single-operator peroral cholangioscopy in patients with primary sclerosing cholangitis. Endoscopy 2015; 47: 696-702.

  41. Siiki A, Rinta-Kiikka I, Koivisto T, Vasama K, Sand J, Laukkarinen J. Spyglass single-operator peroral cholangioscopy seems promising in the evaluation of primary sclerosing cholangitis-related biliary strictures. Scand J Gastroenterol 2014; 49: 1385-90.

  42. Rey JW, Hansen T, Dümcke S, Tresch A, Kramer K, Galle PR, Goetz M, et al. Efficacy of SpyGlass(TM)-directed biopsy compared to brush cytology in obtaining adequate tissue for diagnosis in patients with biliary strictures. World J Gastrointest Endosc 2014; 6: 137-43.

  43. Ehlken H, Zenouzi R, Schramm C. Risk of cholangiocarcinoma in patients with primary sclerosing cholangitis: diagnosis and surveillance. Curr Opin Gastroenterol 2017; 33: 78-84.

  44. Gotthardt DN, Rudolph G, Klöters-Plachky P, Kulaksiz H, Stiehl A. Endoscopic dilation of dominant stenoses in primary sclerosing cholangitis: outcome after long-term treatment. Gastrointest Endosc 2010; 71: 527-34.

  45. Gluck M, Cantone NR, Brandabur JJ, Patterson DJ, Bredfeldt JE, Kozarek RA. A twenty-year experience with endoscopic therapy for symptomatic primary sclerosing cholangitis. J Clin Gastroenterol 2008; 42: 1032-9.

  46. Baluyut AR, Sherman S, Lehman GA, Hoen H, Chalasani N. Impact of endoscopic therapy on the survival of patients with primary sclerosing cholangitis. Gastrointest Endosc 2001; 53: 308-12.

  47. Ponsioen CY, Lam K, van Milligen de Wit AW, Huibregtse K, Tytgat GN. Four years experience with short term stenting in primary sclerosing cholangitis. Am J Gastroenterol 1999; 94: 2403-7.

  48. Kaya M, Petersen BT, Angulo P, Baron TH, Andrews JC, Gostout CJ, Lindor KD. Balloon dilation compared to stenting of dominant strictures in primary sclerosing cholangitis. Am J Gastroenterol 2001; 96: 1059-66.

  49. van Milligen de Wit AW, van Bracht J, Rauws EA, Jones EA, Tytgat GN, Huibregtse K. Endoscopic stent therapy for dominant extrahepatic bile duct strictures in primary sclerosing cholangitis. Gastrointest Endosc 1996; 44: 293-9.

  50. van Milligen de Wit AW, Rauws EA, van Bracht J, Mulder CJ, Jones EA, Tytgat GN, Huibregtse K. Lack of complications following short-term stent therapy for extrahepatic bile duct strictures in primary sclerosing cholangitis. Gastrointest Endosc 1997; 46: 344-7.

  51. Ismail S, Kylänpää L, Mustonen H, Halttunen J, Lindström O, Jokelainen K, Udd M, et al. Risk factors for complications of ERCP in primary sclerosing cholangitis. Endoscopy 2012; 44: 1133-8.

  52. Navaneethan U, Jegadeesan R, Nayak S, Lourdusamy V, Sanaka MR, Vargo JJ, Parsi MA, et al. ERCP-related adverse events in patients with primary sclerosing cholangitis. Gastrointest Endosc 2015; 81: 410-9.

  53. Navaneethan U, Lourdusamy D, Gutierrez NG, Zhu X, Vargo JJ, Parsi MA. New approach to decrease post-ERCP adverse events in patients with primary sclerosing cholangitis. Endosc Int Open 2017; 5: E710-E717.

  54. Culver EL, Chapman RW. Systematic review: management options for primary sclerosing cholangitis and its variant forms - IgG4-associated cholangitis and overlap with autoimmune hepatitis. Aliment Pharmacol Ther 2011; 33: 1273-91.

  55. Bangarulingam SY, Gossard AA, Petersen BT, Ott BJ, Lindor KD. Complications of endoscopic retrograde cholangiopancreatography in primary sclerosing cholangitis. Am J Gastroenterol 2009; 104: 855-60.

  56. Lee JG, Schutz SM, England RE, Leung JW, Cotton PB. Endoscopic therapy of sclerosing cholangitis. Hepatology 1995; 21: 661-7.

  57. Olsson R, Björnsson E, Bäckman L, Friman S, Höckerstedt K, Kaijser B, Olausson M. Bile duct bacterial isolates in primary sclerosing cholangitis: a study of explanted livers. J Hepatol 1998; 28: 426-32.

  58. Othman MO, Guerrero R, Elhanafi S, Davis B, Hernandez J, Houle J, et al. A prospective study of the risk of bacteremia in directed cholangioscopic examination of the common bile duct. Gastrointest Endosc 2016; 83: 151-7.

  59. Wallace MB, Wang KK, Adler DG, Rastogi A. Recent Advances in Endoscopy. Gastroenterology 2017; 153: 364-81.

  60. Moreno Luna LE, Gores GJ. Advances in the diagnosis of cholangiocarcinoma in patients with primary sclerosing cholangitis. Liver Transpl 2006; 12(11, Suppl. 2): S15-S19.

  61. Elmunzer BJ, Scheiman JM, Lehman GA, Chak A, Mosler P, Higgins PD, Hayward RA, et al. A randomized trial of rectal indomethacin to prevent post-ERCP pancreatitis. N Engl J Med 2012; 366: 1414-22.

  62. Elmunzer BJ, Higgins PD, Saini SD, Scheiman JM, Parker RA, Chak A, Romagnuolo J, et al. Does rectal indomethacin eliminate the need for prophylactic pancreatic stent placement in patients undergoing high-risk ERCP? Post hoc efficacy and cost-benefit analyses using prospective clinical trial data. Am J Gastroenterol 2013; 108: 410-5.

  63. Barkin JA, Souto EO, Barkin JS. Rectal indomethacin should be used routinely in all patients for prevention of post-ERCP pancreatitis. Gastrointest Endosc 2017; 85: 687-8.

  64. Buxbaum J, Yan A, Yeh K, Lane C, Nguyen N, Laine L. Aggressive hydration with lactated Ringer's solution reduces pancreatitis after endoscopic retrograde cholangiopancreatography. Clin Gastroenterol Hepatol 2014; 12: 303-7.e1.

  65. Singh VK. High Volume Lactated Ringer’s for Post-Endoscopic Retrograde Cholangiopancreatography Pancreatitis Prophylaxis: Ready for Prime Time. Clin Gastroenterol Hepatol 2017; 15: 93-5.

  66. Barkin JA, Barkin JS. Indomethacin and Short-Duration Intravenous Hydration as a More Feasible Regimen for Risk Reduction of Post-endoscopic Retrograde Cholangiopancreatography Pancreatitis. Clin Gastroenterol Hepatol 2017; 15: 1137-8.

  67. Heif M, Yen RD, Shah RJ. ERCP with probe-based confocal laser endomicroscopy for the evaluation of dominant biliary stenoses in primary sclerosing cholangitis patients. Dig Dis Sci 2013; 58: 2068-74.

  68. Karia K, Jamal-Kabani A, Gaidhane M, Tyberg A, Sharaiha RZ, Kahaleh M. Probe-Based Confocal Endomicroscopy in Primary Sclerosing Cholangitis: Not All Inflammatory Strictures Are the Same. Dig Dis Sci 2016; 61: 283-6.

  69. Keiding S, Hansen SB, Rasmussen HH, Gee A, Kruse A, Roelsgaard K, Tage-Jensen U, et al. Detection of cholangiocarcinoma in primary sclerosing cholangitis by positron emission tomography. Hepatology 1998; 28: 700-6.

  70. Kluge R, Schmidt F, Caca K, Barthel H, Hesse S, Georgi P, Seese A, et al. Positron emission tomography with [(18)F]fluoro-2-deoxy-D-glucose for diagnosis and staging of bile duct cancer. Hepatology 2001; 33: 1029-35.

  71. Prytz H, Keiding S, Björnsson E, Broomé U, Almer S, Castedal M, et al. Dynamic FDG-PET is useful for detection of cholangiocarcinoma in patients with PSC listed for liver transplantation. Hepatology 2006; 44: 1572-80.

  72. Farrell RJ, Agarwal B, Brandwein SL, Underhill J, Chuttani R, Pleskow DK. Intraductal US is a useful adjunct to ERCP for distinguishing malignant from benign biliary strictures. Gastrointest Endosc 2002; 56: 681-7.




2020     |     www.medigraphic.com