Differentiating sclerosing cholangitis caused by autoimmune pancreatitis and primary sclerosing cholangitis according to endoscopic duodenal papillary features - 23/08/11
Reprint requests: Kensuke Kubota, MD, Division of Gastroenterology, Yokohama City University, Graduate School of Medicine, Yokohama, Japan, Fukuura 3-9, Kanazawa, Yokohama 236-0004, Japan.Yokohama, Japan
Abstract |
Background |
Differentiating primary sclerosing cholangitis (PSC) and sclerosing cholangitis caused by autoimmune pancreatitis (SC-AIP) is often challenging. Recently, endoscopic findings of the duodenal papilla in cases with AIP or PSC were reported by Unno and Parlak, although the endoscopic differentiation of these 2 conditions has not yet been fully clarified.
Objective |
Our purpose was to clarify the endoscopic findings of the duodenal papilla in patients with SC-AIP and those with PSC and to determine criteria for the differentiation of these conditions.
Design |
Case series.
Setting |
Retrospective.
Patients |
Twenty-seven patients with SC-AIP and 12 patients with PSC who had undergone ERCP were identified from our database. We reviewed these records to determine whether the duodenal papillary findings (swollen papilla/normal papilla/small papilla) might be potentially useful for differentiating SC-AIP and PSC. Immunohistopathological findings for the duodenal papilla were also examined by using immunoglobulin G4 (IgG4) among the infiltrating plasma cells.
Interventions |
ERCP, biopsy specimen taken from duodenal papilla.
Main Outcome Measurements |
The presence of a swollen duodenal papilla with IgG4-positive plasma cells was useful for discriminating SC-AIP from with PSC.
Results |
A swollen duodenal papilla was observed in 63% (17/27) of the patients with SC-AIP, whereas there was no swelling of the duodenal papilla of the patients with PSC. A small papilla was recognized in 50% (6/12) of the patients with PSC. IgG4-positive plasma cells in the duodenal papilla were significantly detected in the patients with SC-AIP but not in the patients with PSC.
Limitation |
Single-center study.
Conclusions |
Characteristic duodenal endoscopic papillary features in patients with SC-AIP, such as a swollen duodenal papilla and positive immunostaining for IgG4, might be helpful for discriminating this condition from PSC.
Le texte complet de cet article est disponible en PDF.Abbreviations : AIP, HPF, Ig, PSC, SC
Plan
Vol 68 - N° 6
P. 1204-1208 - décembre 2008 Retour au numéro
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