Diagnostic procedures for IgG4-related sclerosing cholangitis.
Summary of "Diagnostic procedures for IgG4-related sclerosing cholangitis."
BACKGROUND/
PURPOSE:
IgG4-related sclerosing cholangitis (IgG4-SC) is one of several diseases associated with autoimmune pancreatitis (AIP). However, diffuse cholangraphic abnormalities seen in association with AIP may resemble those seen in primary sclerosing cholangitis (PSC), and the presence of segmental stenosis suggests cholangiocarcinoma. IgG4-SC responds well to steroid therapy, whereas in contrast, liver transplantation is the only effective therapy for PSC, and surgical intervention is also needed for cholangiocarcinoma. The aim of this review was to establish the diagnostic procedures for IgG4-SC.
METHODS:
A literature search was conducted, covering English-language articles dealing with IgG4-SC published between 1991 and March 2010. As clinical data on IgG4-SC are limited, the author also took into consideration his own clinical experience with the treatment of IgG4-SC over a period of more than 19 years.
RESULTS:
When intrapancreatic stenosis is detected, pancreatic cancer should be ruled out. If multiple intrahepatic stenosis is evident, PSC should be discriminated on the basis of cholangiographic findings and liver biopsy with IgG4 immunostaining. An association with inflammatory bowel disease (IBD) is suggestive of PSC. If stenosis is demonstrated in the hepatic hilar region, cholangiocarcinoma should be discriminated by US, EUS, IDUS, and bile duct biopsy.
CONCLUSION:
For diagnosis of IgG4-SC, coexistence of AIP is the most useful finding. However, the most important consideration for clinicians is to be aware of IgG4-SC when encountering patients with obstructive jaundice.
Affiliation
Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, 467-8601, Japan, tnakazaw@med.nagoya-cu.ac.jp.
Journal Details
This article was published in the following journal.
Name: Journal of hepato-biliary-pancreatic sciences
ISSN: 1868-6982
Pages:
Links
- PubMed Source: http://www.ncbi.nlm.nih.gov/pubmed/20814701
- DOI: http://dx.doi.org/10.1007/s00534-010-0320-2
Medical and Biotech [MESH] Definitions
Punctures
Incision of tissues for injection of medication or for other diagnostic or therapeutic procedures. Punctures of the skin, for example may be used for diagnostic drainage; of blood vessels for diagnostic imaging procedures.
Cholangitis, Sclerosing
Chronic inflammatory disease of the BILIARY TRACT. It is characterized by fibrosis and hardening of the intrahepatic and extrahepatic biliary ductal systems leading to bile duct strictures, CHOLESTASIS, and eventual BILIARY CIRRHOSIS.
Diagnostic Errors
Incorrect diagnoses after clinical examination or technical diagnostic procedures.
Diagnostic Techniques, Radioisotope
Any diagnostic evaluation using radioactive (unstable) isotopes. This diagnosis includes many nuclear medicine procedures as well as radioimmunoassay tests.
Diagnostic Techniques And Procedures
Methods, procedures, and tests performed to diagnose disease, disordered function, or disability.
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