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Small bile duct involvement in IgG4-related sclerosing cholangitis: liver biopsy and cholangiography correlation

  • Original Article—Liver, Pancreas, and Biliary Tract
  • Published:
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Abstract

Background

IgG4-related sclerosing cholangitis (IgG4-SC) needs to be differentiated from primary sclerosing cholangitis (PSC). In this study, we performed a retrospective study to reveal cases in which liver needle biopsy was useful for differential diagnosis.

Methods

Nineteen patients with IgG4-SC and 22 patients with PSC were studied. All patients underwent endoscopic retrograde cholangiography and liver needle biopsy. We defined small bile duct involvement of IgG4-SC histologically as damage to the small bile duct associated with infiltration of ≥10 IgG4+ plasma cells per high power field (HPF). Clinicopathological characteristics were compared between IgG4-SC patients with and without small bile duct involvement.

Results

Small bile duct involvement was observed in 5 (26%) of the patients with IgG4-SC. Patients with small bile duct involvement showed a higher incidence of intrahepatic biliary strictures on cholangiography (80 vs. 21%, p = 0.038). Conversely, 4 of 7 (57%) patients with intrahepatic biliary strictures on cholangiography had histologically evident small duct involvement. The number of IgG4+ plasma cells was significantly correlated with the site of the most proximal stricture on cholangiograms (p = 0.021). The number of IgG4+ plasma cells per HPF was significantly higher in IgG4-SC patients with intrahepatic biliary strictures than in those with PSC (13.4 vs. 0.4 cells/HPF, p < 0.001).

Conclusions

Involvement of small bile ducts is more frequent in patients with intrahepatic biliary strictures on cholangiography, and liver needle biopsy is especially useful for these patients.

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Acknowledgments

This study was supported by the Pancreas Research Foundation of Japan and by Health and Labor Sciences research grants (Research on Specific Diseases, Intractable Diseases of the Pancreas, Ministry of Health Labor and Welfare, Japan).

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Authors and Affiliations

  1. Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, 467-8601, Japan

    Itaru Naitoh, Takahiro Nakazawa, Tomoaki Ando, Kazuki Hayashi, Fumihiro Okumura, Katsuyuki Miyabe, Michihiro Yoshida, Shunsuke Nojiri & Takashi Joh

  2. Institute of Liver Studies, King’s College Hospital, London, UK

    Yoh Zen

  3. Department of Community-based Medical Education, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan

    Takayoshi Kanematsu & Hirotaka Ohara

Authors
  1. Itaru Naitoh
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  2. Yoh Zen
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  3. Takahiro Nakazawa
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  4. Tomoaki Ando
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  5. Kazuki Hayashi
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  7. Katsuyuki Miyabe
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  8. Michihiro Yoshida
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  9. Shunsuke Nojiri
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  10. Takayoshi Kanematsu
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  11. Hirotaka Ohara
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  12. Takashi Joh
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Corresponding author

Correspondence to Takahiro Nakazawa.

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Naitoh, I., Zen, Y., Nakazawa, T. et al. Small bile duct involvement in IgG4-related sclerosing cholangitis: liver biopsy and cholangiography correlation. J Gastroenterol 46, 269–276 (2011). https://doi.org/10.1007/s00535-010-0319-0

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  • DOI: https://doi.org/10.1007/s00535-010-0319-0

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