nach oben

Digestive Diseases and Sciences

Erschienen in:

01.11.2007 | Review Article

Incidence, Diagnosis, and Therapy of Cholangiocarcinoma in Patients with Primary Sclerosing Cholangitis

verfasst von: Johan Fevery, Chris Verslype, Gillian Lai, Raymond Aerts, Werner Van Steenbergen

Erschienen in: Digestive Diseases and Sciences | Ausgabe 11/2007

Einloggen, um Zugang zu erhalten

Abstract

Primary sclerosing cholangitis (PSC) can lead to the development of cholangiocarcinoma (CCA). The tumor may present as an intrahepatic focal cholangiocellular carcinoma but more often as a ductal infiltrating desmoplastic lesion. CCA is found synchronously with the diagnosis of PSC in 20–30% and within 1 year in 50%. During later follow-up, the yearly developmental rate of CCA is 0.5–1.5%. Most patients with PSC and CCA do not yet have cirrhosis but present with a severe stenosis at the hilum of the liver. This type of tumor is difficult to diagnose by imaging techniques.¹⁸F-FDG-PET scanning and CEA or CA 19-9 are not early diagnostic tools. Regular MRI, multislice CT, and repeated endoscopically obtained brush cytology of stenotic lesions are recommended. The recent use of more extensive surgical resection techniques in patients with CCA results in 5-year survival rates of ≥50%. If tumors are small or incidental findings, liver transplantation leads to a 3- to 5-year survival rate of 35%. Pretransplant radiotherapy with 5-FU chemosensitization followed by endoscopic brachytherapy with iridium-192 seems to greatly improve the outcome of transplantation. Treatment with ursodeoxycholic acid may prevent development of CCA.

LaRusso NF, Wiesner RH, Ludwig J (1999) Sclerosing cholangitis. In: Bircher J et al. (eds) Oxford textbook of clinical hepatology. Oxford Medical, New York

Jayaram H, Satsangi J, Chapman RW (2001) Increased colorectal neoplasia in chronic ulcerative colitis complicated by primary sclerosing cholangitis:fact or fiction? Gut 48:430–434PubMedCrossRef

Harnois DM, Gores GJ, Ludwig J, Steers JL, LaRusso NF, Wiesner RH (1997) Are patients with cirrhotic stage primary sclerosing cholangitis at risk for the development of hepatocellular cancer? J Hepatol 27:512–516PubMedCrossRef

Bergquist A, Ekbom A, Olsson R, Kornfeldt D, Loof L, Danielsson A, Hultcrantz R, Lindgren S, Prytz H, Sandberg-Gertzen H, Almer S, Granath F, Broome U (2002) Hepatic and extrahepatic malignancies in primary sclerosing cholangitis. J Hepatol 36:321–327PubMedCrossRef

Gores GJ (2003) Cholangiocarcinoma: current concepts and insights. Hepatology 37:961– 969PubMedCrossRef

Rosen CB, Nagorney DM, Wiesner RH, Coffey Jr RJ, LaRusso NF (1991) Cholangiocarcinoma complicating primary sclerosing cholangitis. Ann Surg 213:21–25PubMedCrossRef

Nashan B, Schlitt HJ, Tusch G, Oldhafer KJ, Ringe B, Wagner S, Pichlmayr R (1996) Biliary malignancies in primary sclerosing cholangitis: timing for liver transplantation. Hepatology 23:1105–1111PubMedCrossRef

Bergquist A, Glaumann H, Persson B, Broomé U (1998) Risk factors and clinical presentation of hepatobiliary carcinoma in patients with primary sclerosing cholangitis—a case control study. Hepatology 27:311–316PubMedCrossRef

Boberg KM, Bergquist A, Mitchell S, Pares A, Rosina F, Broome U, Chapman R, Fausa O, Egeland T, Rocca G, Schrumpf E (2002) Cholangiocarcinoma in primary sclerosing cholangitis: risk factors and clinical presentation. Scand J Gastroenterol 37:1205–1211PubMedCrossRef

10.

Brandsaeter B, Isoniemi H, Broome U, Olausson M, Backman L, Hansen B, Schrumpf E, Oksanen A, Ericzon BG, Hockerstedt K, Makisalo H, Kirkegaard P, Friman S, Bjoro K (2004) Liver transplantation for primary sclerosing cholangitis; predictors and consequences of hepatobiliary malignancy. J Hepatol 40:815–822PubMedCrossRef

11.

Nakeeb A, Tran KQ, Black MJ, Erickson BA, Ritch PS, Quebbeman EJ, Wilson SD, Demeure MJ, Rilling WS, Dua KS, Pitt HA (2002) Improved survival in resected biliary malignancies. Surgery 132:555–563PubMedCrossRef

12.

Anderson, CD, Pinson CW, Berlin J, Chari RS (2004) Diagnosis and treatment of cholangiocarcinoma. Oncologist 9:43–57PubMedCrossRef

13.

Stiehl A, Rudolph G, Kloters-Plachky P, Sauer P, Walker S (2002) Development of dominant bile duct stenoses in patients with primary sclerosing cholangitis treated with ursodeoxycholic acid: outcome after endoscopic treatment. J Hepatol 36:151–156PubMedCrossRef

14.

Okolicsanyi L, Fabris L, Viaggi S, Carulli N, Podda M, Ricci G (1996) Primary sclerosing cholangitis: clinical presentation, natural history and prognostic variables: an Italian multicentre study. Eur J Gastro Hepatol 8:685–691

15.

Lindberg B, Arnelo U, Bergquist A, Thorne A, Hjerpe A, Granqvist S, Hansson LO, Tribukait B, Persson B, Broome U (2002) Diagnosis of biliary strictures in conjunction with endoscopic retrograde cholangiopancreaticography, with special reference to patients with primary sclerosing cholangitis. Endoscopy 34:909–916PubMedCrossRef

16.

Campbell WL, Ferris JV, Holbert BL, Thaete FL, Baron RL (1998) Biliary tract carcinoma complicating primary sclerosing cholangitis: evaluation with CT, cholangiography, US, and MR imaging. Radiology 207:41–50PubMed

17.

American Joint Committee on Cancer (2005) AJCC cancer staging. Springer Verlag, New York

18.

Sirica AE (2005) Cholangiocarcinoma:molecular targeting strategies for chemoprevention and therapy. Hepatology 41:5–15PubMedCrossRef

19.

Jaiswal M, LaRusso NF, Shapiro RA, Billiar TR, Gores GJ (2001) Nitric oxide-mediated inhibition of DNA repair potentiates oxidative DNA damage in cholangiocytes. Gastroenterology 120:190–199PubMedCrossRef

20.

Ahrendt SA, Rashid A, Chow JT, Eisenberger CF, Pitt HA, Sidransky D (2000) p53 overexpression and K ras gene mutations in primary sclerosing cholangitis-associated biliary tract cancer. J Hepatobil Pancreat Surg 7:426–431CrossRef

21.

Boberg KM, Schrumpf E, Bergquist A, Broome U, Pares A, Remotti H, Schjolberg A, Spurkland A, Clausen OP (2000) Cholangiocarcinoma in primary sclerosing cholangitis: K-ras mutations and Tp53 dysfunction are implicated in the neoplastic development. J Hepatol 32:374–380PubMedCrossRef

22.

Kubicka S, Kuhnel F, Flemming P, Hain B, Kezmic N, Rudolph KL, Manns M, Meier PN (2001) K-ras mutations in the bile of patients with primary sclerosing cholangitis. Gut 48:403–408PubMedCrossRef

23.

Rizzi PM, Ryder SD, Portmann B, Ramage JK, Naoumov NV, Williams R (1996) p53 Protein overexpression in cholangiocarcinoma arising in primary sclerosing cholangitis. Gut 38:265–268PubMedCrossRef

24.

Ahrendt SA, Eisenberger CF, Yip L, Rashid A, Chow JT, Pitt HA, Sidransky D (1999) Chromosome 9p21 loss and p16 inactivation in primary sclerosing cholangitis-associated cholangiocarcinoma. J Surg Res 84:88–93PubMedCrossRef

25.

Kornfeld D, Ekbom A, Ihre T (1997) Survival and risk of cholangiocarcinoma in patients with primary sclerosing cholangitis. A population-based study. Scand J Gastroenterol 32:1042–1045PubMed

26.

Burak K, Angulo P, Pasha TM, Egan K, Petz J, Lindor KD (2004) Incidence and risk factors for cholangiocarcinoma in primary sclerosing cholangitis. Am J Gastroenterol 99:523–526PubMedCrossRef

27.

Chalasani N, Baluyut A, Ismail A, Zaman A, Sood G, Ghalib R, McCashland TM, Reddy KR, Zervos X, Anbari MA, Hoen H (2000) Cholangiocarcinoma in patients with primary sclerosing cholangitis: a multicenter case-control study. Hepatology 31:7–11PubMedCrossRef

28.

Broome U, Lofberg R, Veress B, Eriksson LS (1995) Primary sclerosing cholangitis and ulcerative colitis: evidence for increased neoplastic potential. Hepatology 22:1404–1408PubMed

29.

Leidenius M, Hockersted K, Broome U, Ericzon BG, Friman S, Olausson M, Schrumpf E (2001) Hepatobiliary carcinoma in primary sclerosing cholangitis: a case control study. J Hepatol 34:792–798PubMedCrossRef

30.

Ahrendt SA, Pitt HA, Nakeeb A, Klein AS, Lillemoe KD, Kalloo AN, Cameron JL (1999) Diagnosis and management in cholangiocarcinoma in primary sclerosing cholangitis. J Gastrointest Surg 3:357–368PubMedCrossRef

31.

Farrant JM, Hayllar KM, Wilkinson ML, Karani J, Portmann BC, Westaby D, Williams R (1991) Natural history and prognostic variables in primary sclerosing cholangitis. Gastroenterology 100:1710–1717PubMed

32.

Schrumpf E, Abdelnoor M, Fausa O, Elgjo K, Jenssen E, Kolmannskog F (1994) Risk factors in primary sclerosing cholangitis. J Hepatol 21:1061–1066PubMedCrossRef

33.

Broome U, Olsson R, Loof L, Bodemar G, Hultcrantz R, Danielsson A, Prytz H, Sandberg-Gertzen H, Wallerstedt S, Lindberg G (1996) Natural history and prognostic factors in 305 Swedish patients with primary sclerosing cholangitis. Gut 38:610–615PubMedCrossRef

34.

Goss JA, Shackleton CR, Farmer DG, Arnaout WS, Seu P, Markowitz JS, Martin P, Stribling RJ, Goldstein LI, Busuttil RW (1997) Orthotopic liver transplantation for primary sclerosing cholangitis: a 12-year single centre experience. Ann Surg 225:472–483PubMedCrossRef

35.

Björnsson E, Kilander A, Olsson R (1999) CA19-9 and CEA are unreliable markers for cholangiocarcinoma in patients with primary sclerosing cholangitis. Liver 19:501–508PubMedCrossRef

36.

Hultcrantz R, Olsson R, Danielsson A, Jarnerot G, Loof L, Ryden BO, Wahren B, Broome U (1999) A 3-year prospective study on serum tumor markers used for detecting cholangiocarcinoma in patients with primary sclerosing cholangitis. J Hepatol 30:669–673PubMedCrossRef

37.

Vleggaar FP (2000) The risk and prognostic significance of major clinical events, in particular biliary complications, in primary sclerosing cholangitis. Chapter 7 in ``Advances in classification, prognostication and treatment of immunocholangitis.'' PhD thesis, University of Rotterdam.

38.

Kaya M, de Groen PC, Angulo P, Nagorney DM, Gunderson LL, Gores GJ, Haddock MG, Lindor KD (2001) Treatment of cholangiocarcinoma complicating primary sclerosing cholangitis: the Mayo Clinic experience. Am J Gastroenterol 96:1164–1169PubMedCrossRef

39.

Ponsioen CY, Vrouenraets SM, Prawirodirdjo W, Rajaram R, Rauws EA, Mulder CJ, Reitsma JB, Heisterkamp SH, Tytgat GN (2002) Natural history of primary sclerosing cholangitis and prognostic value of cholangiography in a Dutch population. Gut 51:562–566PubMedCrossRef

40.

Bjornsson E, Lindqvist-Ottosson J, Asztely M, Olsson R (2004) Dominant strictures in patients with primary sclerosing cholangitis. Am J Gastroenterol 99:502–508PubMedCrossRef

41.

Solano E, Khakhar A, Bloch M, Quan D, McAlister V, Ghent C, Wall W, Marotta P (2003) Liver transplantation for primary sclerosing cholangitis. Transplant Proc 35:2431–2434PubMedCrossRef

42.

Ito K, Mitchell DG, Outwater EK, Blasberg R (1999) Primary sclerosing cholangitis: MR imaging features. Am J Roentgen 172:1527–1533

43.

Angulo P, Pearce DH, Johnson CD, Henry JJ, LaRusso NF, Petersen BT, Lindor KD (2000) Magnetic resonance cholangiography in patients with biliary disease: its role in primary sclerosing cholangitis. J Hepatol 33:520–527PubMedCrossRef

44.

Clayton RA, Clarke DL, Currie EJ, Madhavan KK, Parks RW, Garden OJ (2003) Incidence of benign pathology in patients undergoing hepatic resection for suspected malignancy. Surgeon 1:32–38PubMedCrossRef

45.

Corvera CU, Blumgart LH, Darvishian F, Klimstra DS,DeMatteo R, Fong Y, D’Angelica M, Jarnagin WR (2005) Clinical and pathologic features of proximal biliary strictures masquerading as hilar cholangiocarcinoma. J Am Coll Surg 201:862–869PubMedCrossRef

46.

Zandrino F, Curone P, Benzi L, Ferretti ML, Musante F (2005) MR versus multislice CT cholangiography in evaluating patients with obstruction of the biliary tract. Abdom Imaging 30:77–85PubMedCrossRef

47.

Keiding S, Hansen SB, Rasmussen HH, Gee A, Kruse A, Roelsgaard K, Tage-Jensen U, Dahlerup JF (1998) Detection of cholangiocarcinoma in primary sclerosing cholangitis by positron emission tomography. Hepatology 28:700–706PubMedCrossRef

48.

Fevery J, Buchel O, Nevens F, Verslype C, Stroobants S, Van Steenbergen W (2005) Positron emission tomography is not a reliable method for the early diagnosis of cholangiocarcinoma in patients with primary sclerosing cholangitis. J Hepatol 43:358– 360PubMedCrossRef

49.

Anderson CD, Rice MH, Pinson CW, Chapman WC, Chari RS, Delbeke D (2004) Fluorodeoxyglucose PET imaging in the evaluation of gallbladder carcinoma and cholangiocarcinoma. J Gastrointest Surg 8:90–97PubMedCrossRef

50.

Fritscher-Ravens A, Broering DC, Knoefel WT, Rogiers X, Swain P, Thonke F, Bobrowski C, Topalidis T, Soehendra N (2004) EUS-guided fine-needle aspiration of suspected hilar cholangiocarcinoma in potentially operable patients with negative brush cytology. Am J Gastroenterol 99:45–51PubMedCrossRef

51.

Eloubeidi MA, Chen VK, Jhala NC, Eltoum IE, Jhala D, Chhieng DC, Syed SA, Vickers SM, Mel Wilcox C (2004) Endoscopic ultrasound-guided fine needle aspiration biopsy of suspected cholangiocarcinoma. Clin Gastroenterol Hepatol 2:209–213PubMedCrossRef

52.

Nichols JC, Gores GJ, LaRusso NF, Wiesner RH, Nagorney DM, Ritts Jr RE (1993) Diagnostic role of serum CA 19-9 for cholangiocarcinoma in patients with primary sclerosing cholangitis. Mayo Clin Proc 68:874–879PubMed

53.

Ramage JK, Donaghy A, Farrant JM, Iorns R, Williams R (1995) Serum tumor markers for the diagnosis of cholangiocarcinoma in primary sclerosing cholangitis. Gastroenterology 108:865– 869PubMedCrossRef

54.

Fisher A, Theise ND, Min A, Mor E, Emre S, Pearl A, Schwartz ME, Miller CM, Sheiner PA (1995) CA19-9 does not predict cholangiocarcinoma in patients with primary sclerosing cholangitis undergoing liver transplantation. Liver Transpl Surg 1:94–98PubMedCrossRef

55.

Siqueira E, Schoen RE, Silverman W, Martin J, Rabinovitz M, Weissfeld JL, Abu-Elmaagd K, Madariaga JR, Slivka A, Martini J (2002) Detecting cholangiocarcinoma in patients with primary sclerosing cholangitis. Gastrointest Endosc 56:40–47PubMedCrossRef

56.

Levy C, Lymp J, Angulo P, Gores GJ, LaRusso N, Lindor KD (2005) The value of serum CA 19-9 in predicting cholangiocarcinomas in patients with primary sclerosing cholangitis. Dig Dis Sci 50:1734–1740PubMedCrossRef

57.

Albert MB, Steinberg WM, Henry JP (1988) Elevated serum levels of tumor marker CA 19-9 in acute cholangitis. Dig Dis Sci 33:1223–1225PubMedCrossRef

58.

Petersen-Benz C, Stiehl A (2005) Impact of dominant stenoses on the serum level of the tumor marker CA19-9 in patients with primary sclerosing cholangitis. Z Gastroenterol. 43:587–590PubMedCrossRef

59.

Ponsioen CY, Vrouenraets SM, van Milligen de Wit AW, Sturm P, Tascilar M, Offerhaus GJ, Prins M, Huibregtse K, Tytgat GN (1999) Value of brush cytology for dominant strictures in primary sclerosing cholangitis. Endoscopy 31:305–309PubMedCrossRef

60.

Rabinovitz M, Zajko AB, Hassanein T, Shetty B, Bron KM, Schade RR, Gavaler JS, Block G, Van Thiel DH, Dekker A (1990) Diagnostic value of brush cytology in the diagnosis of bile duct carcinoma: a study in 65 patients with bile duct strictures. Hepatology 12:747–752PubMedCrossRef

61.

Lal A, Okonkwo A, Schindler S, De Frias D, Nayar R (2004) Role of biliary brush cytology in primary sclerosing cholangitis. Acta Cytol 48:9–12PubMed

62.

Kipp BR, Stadheim LM, Halling SA, et al. (2004) A comparison of routine cytology and fluorescence in situ hybridization for the detection of malignant bile duct strictures. Am J Gastroenterol 99:1675–1681PubMedCrossRef

63.

Ponsioen CY, Lam K, van Milligen de Wit AW, Huibregtse K, Tytgat GN (1999) Four years experience with short term stenting in primary sclerosing cholangitis. Am J Gastroenterol 94:2403–2407PubMedCrossRef

64.

Ahrendt SA, Pitt HA, Kalloo AN, Venbrux AC, Klein AS, Herlong HF, Coleman J, Lillemoe KD, Cameron JL (1998) Primary sclerosing cholangitis: Resect, dilate, or transplant? Ann Surg 227:412–423PubMedCrossRef

65.

Pichlmayr R, Weimann A, Klempnauer J, Oldhafer KJ, Maschek H, Tusch G, Ringe B (1996) Surgical treatment in proximal bile duct cancer. A single-center experience. Ann Surg 224:628–638PubMedCrossRef

66.

Lillemoe KD, Cameron JL (2000) Surgery for hilar cholangiocarcinoma: the Johns Hopkins approach. J Hepatobil Pancreat Surg 7:115–121CrossRef

67.

Nimura Y, Kamiya J, Kondo S, Nagino M, Uesaka K, Oda K, Sano T, Yamamoto H, Hayakawa N (2000) Aggressive preoperative management and extended surgery for hilar cholangiocarcinoma: Nagoya experience. J Hepatobil Pancreat Surg 7:155–162CrossRef

68.

Lee SG, Lee YJ, Park KM, Hwang S, Min PC (2000) One hundred and eleven liver resections for hilar bile duct cancer. J Hepatobil Pancreat Surg 7:135–141CrossRef

69.

Jarnagin WR, Fong Y, De Matteo RP, Gonen M, Burke EC, Bodniewicz J, Youssef M, Klimstra D, Blumgart LH (2001) Staging, resectability and outcome in 225 patients with hilar cholangiocarcinoma. Ann Surg 234:507– 519PubMedCrossRef

70.

Ebata T, Nagino M, Kamiya J, Uesaka K, Nagasaka T, Nimura Y (2003) Hepatectomy with portal vein resection for hilar cholangiocarcinoma: audit of 52 consecutive cases. Ann Surg 238:720–727PubMedCrossRef

71.

Neuhaus P, Jonas S, Settmacher U, Thelen A, Benckert C, Lopez-Hanninen E, Hintze RE (2003) Surgical management of proximal bile duct cancer: extended right lobe resection increases resectability and radicality. Langenbecks Arch Surg 388:194–200PubMedCrossRef

72.

Hemming AW, Reed AI, Fujita S, Foley DP, Howard RJ (2005) Surgical management of hilar cholangiocarcinoma. Ann Surg 241:693–699PubMedCrossRef

73.

Nagino M, Kamiya J, Nishio H, Ebata T, Arai T, Nimura Y (2006) Two hundred forty consecutive portal vein embolizations before extended hepatectomy for biliary cancer: surgical outcome and long-term follow-up. Ann Surg 243:364–372PubMedCrossRef

74.

Abdel Wahab AM, Fathy O, Elghwalby N, Sultan A, Elebidy E, Abdalla T, Elshobary M, Mostafa M, Foad A, Kandeel T, Abdel Raouf A, Salah T, Abu Zeid M, Abu Elenein A, Gad Elhak N, ElFiky A, Ezzat F (2006) Resectability and prognostic factors after resection of hilar cholangiocarcinoma. Hepatogastroenterology 53:5–10PubMed

75.

Otto G (2007) Diagnostic and surgical approaches in hilar cholangiocarcinoma. Int J Colorectal Dis 22:101–108

76.

Tsao JI, Nimura Y, Kamiya J, Hayakawa N, Kondo M, Uesaka K, Oda K, Rossi RL, Braasch JW, Dugan JM (2000) Management of hilar cholangiocarcinoma: comparison of an American and Japanese experience. Ann Surg 232:166–174PubMedCrossRef

77.

Zervos EE, Osborne D, Goldin SB, Villadolid DV, Thometz DP, Durkin A, Carey LC, Rosemurgy AS (2005) Stage does not predict survival after resection of hilar cholangiocarcinomas promoting an aggressive operative approach. Am J Surg 190:810– 815PubMedCrossRef

78.

79.

Todoroki T, Ohara K, Kawamoto T, Koike N, Yoshida S, Kashiwagi H, Otsuka M, Fukao K (2000) Benefits of adjuvant radiotherapy after radical resection of locally advanced main hepatic duct carcinoma. Int J Radiat Oncol Biol Phys 46:581–587PubMedCrossRef

80.

Itoh H, Nishijima K, Kurosaka Y, Takegawa S, Kiriyama M, Dohba S, Kojima Y, Saitoh Y (2005) Magnitude of combination therapy of radical resection and external beam radiotherapy for patients with carcinomas of the extrahepatic bile duct and gallbladder. Dig Dis Sci 50:2231–2242PubMedCrossRef

81.

Jan YY, Yeh CN, Yeh TS, Chen TC (2005) Prognostic analysis of surgical treatment of peripheral cholangiocarcinoma: two decades of experience at Chang Gung Memorial Hospital. World J Gastroenterol 11:1779–1784PubMed

82.

Madariaga JR, Iwatsuki S, Todo S, Lee RG, Irish W, Starzl TE (1998) Liver resection for hilar and peripheral cholangiocarcinomas: a study of 62 cases. Ann Surg 227:70–79PubMedCrossRef

83.

Graziadei IW, Wiesner RH, Marotta PJ, Porayko MK, Hay JE, Charlton MR, Poterucha JJ, Rosen CB, Gores GJ, LaRusso NF, Krom RA (1999) Long-term results of patients undergoing liver transplantation for primary sclerosing cholangitis. Hepatology 30:1121–1127PubMedCrossRef

84.

Maheshwari A, Yoo HY, Thuluvath PJ (2004) Long-term outcome of liver transplantation in patients with PSC: a comparative analysis with PBC. Am J Gastroenterol 99:538–542PubMedCrossRef

85.

Ghali P, Marotta PJ, Yoshida EM, Bain VG, Marleau D, Peltekian K, Metrakos P, Deschênes M (2005) Liver transplantation for incidental cholangiocarcinoma: analysis of the Canadian experience. Incidental CCA was documented in 8 patients with PSC, transplanted between 1996 and 2003. The 3-year survival rate was 30%. Liver Transpl 11:1412–1416PubMedCrossRef

86.

Meyer CG, Penn I, James L (2000) Liver transplantation for cholangiocarcinoma: results in 207 patients. Transplantation 69:1633–1637PubMedCrossRef

87.

Robles R, Figueras J, Turrion VS, Margarit C, Moya A, Varo E, Calleja J, Valdevieso A, Valdecasas JCG, Lopez P, Gomez M, de Vicente E, Loinaz C, Santoyo J, Fleitas M, Bernados A, Llado L, Ramirez P, Bueno FS, Jaurrieta E, Parrilla P (2004) Spanish experience in liver transplantation for hilar and peripheral cholangiocarcinoma. Ann Surg 239:265–271PubMedCrossRef

88.

Bjøro K, Brandsæter B, Foss A, Schrumpf E (2005) Liver transplantation in primary sclerosing cholangitis. Sem Liver Dis 26:69–79CrossRef

89.

Pascher A, Jonas S, Neuhaus P (2003) Intrahepatic cholangiocarcinoma: indication for transplantation. J Hepatobil Pancreat Surg 10:282–287CrossRef

90.

Rea DJ, Heimbach JK, Rosen CB, Haddock MG, Alberts SR, Kremers WK, Gores GJ, Nagorney DM (2005) Liver transplantation with neoadjuvant chemoradiation is more effective than resection for hilar cholangiocarcinoma. Ann Surg 242:451– 461PubMed

91.

Sudan D, DeRoover A, Chinnakotla S, Fox I, Shaw Jr B, McCashland T, Sorrell M, Tempero M, Langnas A (2002) Radiochemotherapy and transplantation allow long-term survival for nonresectable hilar cholangiocarcinoma. Am J Transplant 2:774–779PubMedCrossRef

92.

Blendis L, Lurie Y (2002) Primary sclerosing cholangitis: a premalignant condition. Gastroenterology 123:647–648PubMedCrossRef

93.

Alpini G, Glaser SS, Ueno Y, Rodgers R, Phinizy JL, Francis H, Baiocchi L, Holcomb LA, Caligiuri A, LeSage GD (1999) Bile acid feeding induces cholangiocyte proliferation and secretion: evidence for bile acid-regulated ductal secretion. Gastroenterology 116:179–186PubMedCrossRef

94.

Alpini G, Kanno N, Phinizy JL, Glaser S, Francis H, Taffetani S, LeSage G (2004) Tauroursodeoxycholate inhibits human cholangiocarcinoma growth via Ca2+-, PKC-, and MAPK-dependent pathways. Am J Physiol Gastrointest Liver Physiol 286:G973–G982PubMedCrossRef

95.

Tung BY, Emond MJ, Haggitt RC, Bronner MP, Kimmey MB, Kowdley KV, Brentnall TA (2001) Ursodiol use is associated with lower prevalence of colonic neoplasia in patients with ulcerative colitis and primary sclerosing cholangitis. Ann Intern Med 134:89–95PubMed

96.

Pardi DS, Loftus Jr EV, Kremers WK, Keach J, Lindor KD (2003) Ursodeoxycholic acid as a chemopreventive agent in patients with ulcerative colitis and primary sclerosing cholangitis. Gastroenterology 124:889–893PubMedCrossRef

97.

Serfaty L, De Leusse A, Rosmorduc O, Desaint B, Flejou JF, Chazouilleres O, Poupon RE, Poupon R (2003) Ursodeoxycholic acid therapy and the risk of colorectal adenoma in patients with primary biliary cirrhosis: an observational study. Hepatology 38:203–209PubMedCrossRef

98.

Alberts DS, Martinez ME, Hess LM, Einspahr JG, Green SB, Bhattacharyya AK, Guillen J, Krutzsch M, Batta AK, Salen G, Fales L, Koonce K, Parish D, Clouser M, Roe D, Lance P, Phoenix and Tucson Gastroenterologist Networks (2005) Phase III trial of ursodeoxycholic acid to prevent colorectal adenoma recurrence. J Natl Cancer Inst 97:846–853PubMedCrossRef

Titel: Incidence, Diagnosis, and Therapy of Cholangiocarcinoma in Patients with Primary Sclerosing Cholangitis
verfasst von: Johan Fevery
Chris Verslype
Gillian Lai
Raymond Aerts
Werner Van Steenbergen
Publikationsdatum: 01.11.2007
Verlag: Springer US
Erschienen in: Digestive Diseases and Sciences / Ausgabe 11/2007
Print ISSN: 0163-2116
Elektronische ISSN: 1573-2568
DOI: https://doi.org/10.1007/s10620-006-9681-4

Leitlinien kompakt für die Innere Medizin

Mit medbee Pocketcards sicher entscheiden.

^{Seit 2022 gehört die medbee GmbH zum Springer Medizin Verlag}

Kostenlos registrieren

Neu im Fachgebiet Innere Medizin

Notfall-TEP der Hüfte ist auch bei 90-Jährigen machbar

26.04.2024 Hüft-TEP Nachrichten

Ob bei einer Notfalloperation nach Schenkelhalsfraktur eine Hemiarthroplastik oder eine totale Endoprothese (TEP) eingebaut wird, sollte nicht allein vom Alter der Patientinnen und Patienten abhängen. Auch über 90-Jährige können von der TEP profitieren.

Niedriger diastolischer Blutdruck erhöht Risiko für schwere kardiovaskuläre Komplikationen

25.04.2024 Hypotonie Nachrichten

Wenn unter einer medikamentösen Hochdrucktherapie der diastolische Blutdruck in den Keller geht, steigt das Risiko für schwere kardiovaskuläre Ereignisse: Darauf deutet eine Sekundäranalyse der SPRINT-Studie hin.

Bei schweren Reaktionen auf Insektenstiche empfiehlt sich eine spezifische Immuntherapie

25.04.2024 Allergien und Intoleranzreaktionen Nachrichten

Insektenstiche sind bei Erwachsenen die häufigsten Auslöser einer Anaphylaxie. Einen wirksamen Schutz vor schweren anaphylaktischen Reaktionen bietet die allergenspezifische Immuntherapie. Jedoch kommt sie noch viel zu selten zum Einsatz.

Therapiestart mit Blutdrucksenkern erhöht Frakturrisiko

25.04.2024 Hypertonie Nachrichten

Beginnen ältere Männer im Pflegeheim eine Antihypertensiva-Therapie, dann ist die Frakturrate in den folgenden 30 Tagen mehr als verdoppelt. Besonders häufig stürzen Demenzkranke und Männer, die erstmals Blutdrucksenker nehmen. Dafür spricht eine Analyse unter US-Veteranen.

Update Innere Medizin

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

Newsletter bestellen

Springer Medizin

Abstract

Bitte loggen Sie sich ein, um Zugang zu diesem Inhalt zu erhalten

Weitere Artikel der Ausgabe 11/2007

Causes of Death in Patients with Unresectable Hepatocellular Carcinoma

Fulminant Hepatic Failure in an African Setting: Etiology, Clinical Course, and Predictors of Mortality

Recurrent Gastrinoma in the Mesentery 19 Years After Primary Resection

Factors Prognostic of Survival in Patients Awaiting Liver Transplantation for End-Stage Liver Disease

Effects of Motilin and Mitemcinal (GM-611) on Gastrointestinal Contractile Activity in Rhesus Monkeys In Vivo and In Vitro