摘要
Primary sclerosing cholangitis(PSC) is a chronic,cholestatic liver condition characterized by inflammation,fibrosis,and destruction of the intra-and extrahepatic bile ducts.The therapeutic endoscopist plays a key role in the diagnosis and management of PSC.In patients presenting with a cholestatic profile,endoscopic retrograde cholangiopancreatography(ERCP) is warranted for a definite diagnosis of PSC.Dominant strictures of the bile duct occur in 36%-57% of PSC patients.Endoscopic balloon dilatation with or without stenting have been employed in the management of dominant strictures.In addition,PSC patients are at increased risk of developing cholangiocarcinoma with a 20% lifetime risk.Brush cytology obtained during ERCP and use of fluorescence in situ hybridization forms the initial diagnostic step in the investigation of patients with dominant biliary strictures.Our review aims to summarize the current evidence supporting the role of a therapeutic endoscopist in the management of PSC patients.
Primary sclerosing cholangitis (PSC) is a chronic, cholestaticliver condition characterized by inflammation,fibrosis, and destruction of the intra- and extrahepaticbile ducts. The therapeutic endoscopist plays a key rolein the diagnosis and management of PSC. In patientspresenting with a cholestatic profile, endoscopic retrogradecholangiopancreatography (ERCP) is warrantedfor a definite diagnosis of PSC. Dominant strictures of thebile duct occur in 36%-57% of PSC patients. Endoscopicballoon dilatation with or without stenting have beenemployed in the management of dominant strictures. Inaddition, PSC patients are at increased risk of developingcholangiocarcinoma with a 20% lifetime risk. Brushcytology obtained during ERCP and use of fluorescencein situ hybridization forms the initial diagnostic step in theinvestigation of patients with dominant biliary strictures.Our review aims to summarize the current evidencesupporting the role of a therapeutic endoscopist in themanagement of PSC patients.
基金
Research Grants from the Inflammatory Bowel Disease Working Group and the American College of Gastroenterology(to Navaneethan U)