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...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.展开更多
Primary sclerosing cholangitis(PSC)is a chronic,idiopathic,cholestatic liver disease characterized by inflammation and fibrosis of the intrahepatic and/or extrahepatic bile ducts.It can affect individuals of all age g...Primary sclerosing cholangitis(PSC)is a chronic,idiopathic,cholestatic liver disease characterized by inflammation and fibrosis of the intrahepatic and/or extrahepatic bile ducts.It can affect individuals of all age groups and gender,has no established pharmacotherapy,and is associated with a variety of neoplastic(e.g.cholangiocarcinoma)and non-neoplastic(e.g.dominant strictures)hepatobiliary complications.Given these considerations,endoscopy plays a major role in the care of patients with PSC.In this review,we discuss and provide updates regarding endoscopic considerations in the management of hepatobiliary manifestations and complications of PSC.Where evidence is limited,we suggest pragmatic approaches based on currently available data and expert opinion.展开更多
基金Research Grants from the Inflammatory Bowel Disease Working Group and the American College of Gastroenterology(to Navaneethan U)
文摘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.
基金This work was completed in part through T32 fellowship funding support for Dr.J.H.Tabibian from the United States National Institutes of Health(grant DK007198).
文摘Primary sclerosing cholangitis(PSC)is a chronic,idiopathic,cholestatic liver disease characterized by inflammation and fibrosis of the intrahepatic and/or extrahepatic bile ducts.It can affect individuals of all age groups and gender,has no established pharmacotherapy,and is associated with a variety of neoplastic(e.g.cholangiocarcinoma)and non-neoplastic(e.g.dominant strictures)hepatobiliary complications.Given these considerations,endoscopy plays a major role in the care of patients with PSC.In this review,we discuss and provide updates regarding endoscopic considerations in the management of hepatobiliary manifestations and complications of PSC.Where evidence is limited,we suggest pragmatic approaches based on currently available data and expert opinion.