Original Article: Clinical EndoscopyEndoscopic dilation of dominant stenoses in primary sclerosing cholangitis: outcome after long-term treatmentDisclosure,
Section snippets
Study design
This prospective study began in May 1987 and continued until July 2006. The outcomes of all patients in the study were followed until June 2007.
Patient selection and characteristics
The selection criteria for enrolling patients with PSC in the study included typical endoscopic retrograde cholangiography (ERC) findings, serum alkaline phosphatase activity of at least twice the normal range, negative antimitochondrial antibody, and liver biopsy findings compatible with the diagnosis of PSC. Routine laboratory values were determined
Results
Total or subtotal stenoses of major bile ducts were found in 97 patients (1 with choledochojejunostomy had a cholangiocarcinoma) (Table 1). Of 96 carcinoma-free patients, 37 were symptomatic, 32 had jaundice with a serum bilirubin level greater than 2 mg/dL, 6 patients had jaundice as well as pruritus, and 5 had pruritus without jaundice; 41 patients were subicteric and had a serum bilirubin level of 1.0 to 2.0 mg/dL. Of the 23 patients with normal serum bilirubin levels, 10 had intermittently
Discussion
In PSC, dominant stenoses of major bile ducts may lead to severe cholestasis, are associated with reduced survival,24 and in general require endoscopic opening.13, 15, 16, 17, 18, 19, 20, 21, 22, 23 Originally it was thought that short-segment stenoses may be opened endoscopically, whereas there was little experience with the opening of long-segment stenoses. In recent years, it became clear that long-segment stenoses of the common duct more than 2 cm in length may be dilated and kept open for
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2022, Clinics in Liver DiseaseCitation Excerpt :Among endoscopic therapies, biliary endoscopic balloon dilation (EBD) is generally preferred over endoscopic biliary stenting (EBS) in the management of long PSC strictures, whenever malignancy is excluded.26 Gotthardt and colleagues in 2010 reported single-center 20-year experience of their cohort of patients with PSC (n = 171), of which 20 had DS at initiation period, and 77 more patients developed DS over time.27 500 serial EBD were performed over the years, with reported adverse events of pancreatitis (2.2%), bacterial cholangitis (1.4%), and bile duct perforation (0.2%), whereas only 5 patients with complete obstruction with bacterial cholangitis were stented.27
- Disclosure
All authors disclosed no financial relationships relevant to this publication.
See CME section; p. 596
Current affiliations: Department of Medicine (D.G., G.R., P.K.-P., A.S.), University of Heidelberg, Heidelberg, Germany, Department of Medicine (H.K.), University of Ulm, Ulm, Federal Republic of Germany.