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Two cases of immunoglobulin G4-related sclerosing cholangitis in which transabdominal ultrasonography was useful in diagnosis and follow-up observation

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Abstract

Immunoglobulin G4-related disease (IgG4-RD) represents a group of disorders that share features of inflammation, plasma cell infiltrates, and fibrosis. Sclerosing cholangitis is a disorder involving inflammation, scarring, and destruction of the bile ducts. IgG4-related sclerosing cholangitis (IgG4-SC) has been proposed as a bile duct lesion associated with IgG4-RD. This disease entity can be distinguished from other types of sclerosing cholangitis and classified into four types based upon the region of strictures revealed by cholangiography. Here, we present two cases in which the finding of bile duct wall thickening visualized with transabdominal ultrasonography was useful in the diagnosis of patients with IgG4-SC. At present, transabdominal ultrasonography is not included in the diagnostic algorithm for IgG4-SC. We are certain that detailed observation of the bile duct wall with transabdominal ultrasonography can make a significant contribution to the diagnosis of IgG4-SC. Furthermore, we propose that transabdominal ultrasonography may be useful in following clinical improvement in cases where a steroid trial is the best option for treatment. Both cases emphasize the practicality of transabdominal ultrasonography in the diagnosis and follow-up observation of IgG4-SC.

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References

  1. Nakazawa T, Ohara H, Sano H, et al. Schematic classification of sclerosing cholangitis with autoimmune pancreatitis by cholangiography. Pancreas. 2006;32:229.

    Article  PubMed  Google Scholar 

  2. Kobayashi G, Fujita N, Noda Y. Autoimmune pancreatitis: with special reference to a localized variant. J Med Ultrason. 2008;35:41–50.

    Article  Google Scholar 

  3. Ohara H, Okazaki K, Tsubouchi H, et al. Clinical diagnostic criteria of IgG4-related sclerosing cholangitis 2012. J Hepatobiliary Pancreat Sci. 2012;19:536–42.

    Article  PubMed  Google Scholar 

  4. Kamisawa T, Okamoto A. IgG4-related sclerosing disease. World J Gastroenterol. 2008;14:3948–55.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  5. Horiguchi S, Ikeda F, Shiraha H, et al. Diagnostic usefulness of precise examinations with intraductal ultrasonography, peroral cholangioscopy and laparoscopy of immunoglobulin G4-related sclerosing cholangitis. Dig Endosc. 2012;24:370–3.

    Article  PubMed  Google Scholar 

  6. Nakazawa T, Naitoh I, Hayashi K. Usefulness of intraductal ultrasonography in the diagnosis of cholangiocarcinoma and IgG4-related sclerosing cholangitis. Clin Endosc. 2012;45:331–6.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Kamisawa T, Ohara H, Kim MH, et al. Role of endoscopy in the diagnosis of autoimmune pancreatitis and immunoglobulin G4-related sclerosing cholangitis. Dig Endosc. 2014;26:627–35.

    Article  PubMed  Google Scholar 

  8. Naitoh I, Nakazawa T, Ohara H, et al. Endoscopic transpapillary intraductal ultrasonography and biopsy in the diagnosis of IgG4-related sclerosing cholangitis. J Gastroenterol. 2009;44:1147–55.

    Article  PubMed  Google Scholar 

  9. Tamada K, Tomiyama T, Wada S, et al. Endoscopic transpapillary bile duct biopsy with the combination of intraductal ultrasonography in the diagnosis of biliary strictures. Gut. 2002;50:326–31.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  10. Nakazawa T, Naitoh I, Hayashi K, et al. Diagnosis of IgG4-related sclerosing cholangitis. World J Gastroenterol. 2013;19:7661–70.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  11. Nakazawa T, Naitoh I, Hayashi K, et al. Diagnostic criteria for IgG4-related sclerosing cholangitis based on cholangiographic classification. J Gastroenterol. 2012;47:79–87.

    Article  CAS  PubMed  Google Scholar 

  12. Naitoh I, Nakazawa T, Hayashi K, et al. Comparison of intraductal ultrasonography findings between primary sclerosing cholangitis and IgG4-related sclerosing cholangitis. J Gastroenterol Hepatol. 2015;30:1104–9.

    Article  PubMed  Google Scholar 

  13. Carroll BA, Oppenheimer DA. Sclerosing cholangitis: sonographic demonstration of bile duct wall thickening. AJR Am J Roentgenol. 1982;139:1016–8.

    Article  CAS  PubMed  Google Scholar 

  14. Tamada K, Ushio J, Sugano K. Endoscopic diagnosis of extrahepatic bile duct carcinoma: advances and current limitations. World J Clin Oncol. 2011;2:203–16.

    PubMed  PubMed Central  Google Scholar 

  15. Nakazawa T, Ando T, Hayashi K, et al. Diagnostic procedures for IgG4-related sclerosing cholangitis. J Hepatobiliary Pancreat Sci. 2011;18:127–36.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Gastroenterology, Dokkyo Medical University Koshigaya Hospital, 2-1-50 Minami-Koshigaya, Koshigaya, Saitama, 343-8555, Japan

    Ikuhiro Kobori, Toshikuni Suda, Akihiro Nakamoto, Hiroki Saito, Osamu Okawa, Rion Sudo, Yoshinori Gyotoku, Yasumi Katayama & Masaya Tamano

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  1. Ikuhiro Kobori
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  2. Toshikuni Suda
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  3. Akihiro Nakamoto
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  4. Hiroki Saito
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  5. Osamu Okawa
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  6. Rion Sudo
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  7. Yoshinori Gyotoku
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  8. Yasumi Katayama
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  9. Masaya Tamano
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Corresponding author

Correspondence to Masaya Tamano.

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Conflict of interest

Ikuhiro Kobori, Toshikuni Suda, Akihiro Nakamoto, Hiroki Saito, Osamu Okawa, Rion Sudo, Yoshinori Gyotoku, Yasumi Katayama, and Masaya Tamano declare that they have no conflicts of interest.

Human rights statements and informed consent

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2008 (5). Informed consent was obtained from all patients included in the study. Additional informed consent was obtained from all patients for whom identifying information is included in this article.

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Kobori, I., Suda, T., Nakamoto, A. et al. Two cases of immunoglobulin G4-related sclerosing cholangitis in which transabdominal ultrasonography was useful in diagnosis and follow-up observation. J Med Ultrasonics 43, 271–277 (2016). https://doi.org/10.1007/s10396-015-0676-7

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  • DOI: https://doi.org/10.1007/s10396-015-0676-7

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