Sclerosing cholangitis associated with autoimmune pancreatitis differs from primary sclerosing cholangitis

AIM:To clarify the characteristic features of biliary le-sions in patients with autoimmune pancreatitis(AIP) and compare them with those of primary sclerosing cholangitis(PSC) .METHODS:The clinicopathological characteristics of 34 patients with sclerosing cholangitis(SC) associated with AIP were compared with those of 4 patients with PSC.RESULTS:SC with AIP occurred predominantly in el-derly men.Obstructive jaundice was the most frequent initial symptom in SC with AIP.Only SC patients with AIP had elevated serum IgG4 levels,and sclerosing diseases were more frequent in these patients.SC pa-tients with AIP responded well to steroid therapy.Seg-mental stenosis of the lower bile duct was observed only in SC patients with AIP,but a beaded and pruned-tree appearance was detected only in PSC patients.Dense infi ltration of IgG4-positive plasma cells was de-tected in the bile duct wall and the periportal area,as well as in the pancreas,of SC patients with AIP.CONCLUSION:SC with AIP is distinctly different from PSC.The two diseases can be discriminated based on cholangiopancreatographic findings and serum IgG4 levels.

Endoscopic hemostasis techniques for upper gastrointestinal hemorrhage: A review

Upper gastrointestinal hemorrhage (UGIH) is an urgent disease that is often encountered in daily medical practice. Endoscopic hemostasis is currently indispensable for the treatment of UGIH. Initially, when UGIH is suspected, a cause of UGIH is presumed from the medical interview and physical findings. After ample primary treatment, urgent endoscopy is performed. Many methods of endoscopic hemostasis are in wide use, including hemoclip, injection and thermo-coagulation methods. Although UGIH develops from a wide variety of diseases, such as esophageal varices and gastric and duodenal ulcer, hemostasis is almost always possible. Identification of the causative diseases, primary treatment and characteristic features of endoscopic hemostasis are needed to allow appropriate treatment.

Diagnosis and clinical implications of pancreatobiliary reflux

Oddi 的括约肌在远侧的结束被定位胰腺并且胆汁管并且调整胆汁和胰液的流出。一条普通隧道能那么长连接胰腺并且胆汁管在十二指肠的墙外面被定位，，发生在 pancreaticobiliary maljunction (PBM ) ；在如此的情况中，括约肌行动机能上地不影响连接。因为在胰腺的管以内的水疗院压力通常比在胆汁管大，胰液经常倒流进在 PBM 的胆汁的管(pancreatobiliary 倒流) ，导致致癌物在胆道的非位的条件。Pancreatobiliary 倒流能经由次要的十二指肠的乳头状的小突起在胆汁，刺激分泌素的动态磁性的回声 cholangiopancreatography，和 pancreatography 从提高的淀粉酶水平被诊断。最近，没有 PBM， pancreatobiliary 倒流能发生在个人，变得明显。没有 PBM， Pancreatobiliary 倒流可能甚至在一些个人与胆汁的致癌作用有关。因为很少全身的研究与正常 pancreaticobiliary 连接在个人关于 pancreatobiliary 倒流的临床的关联和含意存在，包括适当管理的进一步未来的临床的研究应该被执行。

Endoscopic approach for diagnosing autoimmune pancreatitis

It is of utmost importance to differentiate autoimmune pancreatitis(AIP) from pancreatic cancer(PC).Segmental AIP cases are sometimes difficult to differentiate from PC.On endoscopic retrograde cholangio pancreatography,long or skipped irregular narrowing of the main pancreatic duct(MPD),less upstream dilatation of the distal MPD,side branches derived from the narrowed portion of the MPD,absence of obstruction of the MPD,and stenosis of the intrahepatic bile duct suggest AIP rather than PC.Abundant infiltration of IgG4-positive plasma cells is frequently and rather specifically detected in the major duodenal papilla of AIP patients.IgG4-immunostaining of biopsy specimens obtained from the major duodenal papilla is useful for supporting a diagnosis of AIP with pancreatic head involvement.On endoscopic ultrasonography(EUS),hyperechoic spots in the hypoechoic mass and the duct-penetrating sign suggest AIP rather than PC.EUS and intraductal ultrasonography sometimes show wall thickening of the common bile duct even in the segment in which abnormalities are not clearly observed with cholangiography in AIP patients.EUS-guided fine needle aspiration,especially EUS-guided Tru-Cut biopsy,is useful to diagnose AIP,as well as to exclude PC.