Original ArticleCholangiography can discriminate sclerosing cholangitis with autoimmune pancreatitis from primary sclerosing cholangitis
Section snippets
Patients and methods
ERCP was performed in 8407 patients and percutaneous transhepatic biliary drainage (PTBD) in 1421 patients (1989-2003). Of the total, 31 met criteria for PSC.8 Of these 31 patients, two were excluded; one because the quality of the cholangiograms was poor and the other because of the presence of bile duct stones.
There also were 27 patients who met the criteria for AIP proposed by the Japanese Pancreatic Society as follows9: (1) diffuse narrowing of the main pancreatic duct with an irregular
Results
Biliary stenosis was mainly observed in the extrahepatic ducts of patients with SC with AIP. Stenosis was noted in both the intrahepatic and extrahepatic ducts with PSC, except for two cases in which it was present only in the intrahepatic ducts (Table 1). The most prominent cholangiographic feature of SC with AIP was stenosis of the distal common bile duct. However, sclerosing changes in the intrahepatic and extrahepatic bile ducts or stricture in the hilar region also were observed in half of
Discussion
Visualization of the biliary tract is essential for confirmation of the diagnosis of PSC; endoscopic retrograde cholangiography is the method of choice. Adequate cholangiograms also can be obtained via a percutaneous transhepatic approach. The typical cholangiographic findings of PSC include multifocal beading of both the intrahepatic and the extrahepatic biliary tree. The intrahepatic bile ducts alone or of the extrahepatic bile ducts alone can be involved. Strictures are typically diffusely
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