nach oben

Current Hepatology Reports

Erschienen in:

21.04.2020 | Autoimmune, Cholestatic, and Biliary Diseases (S Gordon and CL Bowlus, Section Editors)

The Role of Cholangioscopy in the Management of Primary Sclerosing Cholangitis

verfasst von: Aldo J. Montano-Loza, Maryam Ebadi, Gurpal Sandha

Erschienen in: Current Hepatology Reports | Ausgabe 2/2020

Einloggen, um Zugang zu erhalten

Abstract

Purpose of Review

Primary sclerosing cholangitis (PSC) is a chronic cholestatic liver disease characterized by inflammation and fibrosis of the biliary ducts associated with a high risk for hepatobiliary malignancies. Up to 50% of PSC patients develop dominant strictures (DS) and warrant investigations to exclude cholangiocarcinoma (CCA). Most patients undergo endoscopic retrograde cholangiopancreatography (ERCP) with brush cytology, but diagnostic accuracy is suboptimal, with sensitivity varying between 8 and 43% for the detection of CCA. Negative brush cytology often results in repeat ERCPs and need for heightened surveillance.

Recent Findings

The relatively recent introduction of per oral single operator cholangioscopy (SOC) as a safe and efficient complementary tool to ERCP allows for visual characterization and direct targeted forceps biopsy acquisition, with some studies showing sensitivity of up to 90% for overall diagnostic performance. However, most of the data for SOC in PSC comes from retrospective single-center studies.

Summary

SOC allows visual characterization and direct targeted biopsies, with some studies demonstrating superior diagnostic performance for CCA detection in PSC. In addition, SOC may have potential benefit in characterization of different phenotypes of DS in PSC.

Lazaridis KN, LaRusso NF. Primary sclerosing cholangitis. N Engl J Med. 2016;375:1161–70. https://doi.org/10.1056/NEJMra1506330.CrossRefPubMedPubMedCentral

Karlsen TH, Folseraas T, Thorburn D, Vesterhus M. Primary sclerosing cholangitis - a comprehensive review. J Hepatol. 2017;67:1298–323. https://doi.org/10.1016/j.jhep.2017.07.022.CrossRefPubMed

Dyson JK, Beuers U, Jones DEJ, Lohse AW, Hudson M. Primary sclerosing cholangitis. Lancet. 2018;39:2547–59. https://doi.org/10.1016/S0140-6736(18)30300-3.CrossRef

Bambha K, Kim WR, Talwalkar J, Torgerson H, Benson JT, Therneau TM, et al. Incidence, clinical spectrum, and outcomes of primary sclerosing cholangitis in a United States community. Gastroenterology. 2003;125:1364–9. https://doi.org/10.1016/j.gastro.2003.07.011.CrossRefPubMed

Lindkvist B, de Benito Valle M, Gullberg B, Bjornsson E. Incidence and prevalence of primary sclerosing cholangitis in a defined adult population in Sweden. Hepatology. 2010;52:571–7. https://doi.org/10.1002/hep.23678.CrossRefPubMed

Boonstra K, Weersma RK, van Erpecum KJ, Rauws EA, Spanier BW, Poen AC, et al. Population-based epidemiology, malignancy risk, and outcome of primary sclerosing cholangitis. Hepatology. 2013;58:2045–55. https://doi.org/10.1002/hep.26565.CrossRefPubMed

Weismuller TJ, Trivedi PJ, Bergquist A, Imam M, Lenzen H, Ponsioen CY, et al. Patient age, sex, and inflammatory bowel disease phenotype associate with course of primary sclerosing cholangitis. Gastroenterology. 2017;152:1975–84 e8. https://doi.org/10.1053/j.gastro.2017.02.038.CrossRefPubMedPubMedCentral

Kim WR, Poterucha JJ, Wiesner RH, LaRusso NF, Lindor KD, Petz J, et al. The relative role of the Child-Pugh classification and the Mayo natural history model in the assessment of survival in patients with primary sclerosing cholangitis. Hepatology. 1999;29:1643–8. https://doi.org/10.1002/hep.510290607.CrossRefPubMed

Eaton JE, Vesterhus M, McCauley BM, Atkinson EJ, Schlicht EM, Juran BD, et al. Primary sclerosing cholangitis risk estimate tool (PREsTo) predicts outcomes of the disease: a derivation and validation study using machine learning. Hepatology. 2020;71(1):214–24. https://doi.org/10.1002/hep.30085.CrossRefPubMed

10.

Goode EC, Clark AB, Mells GF, Srivastava B, Spiess K, Gelson WTH, et al. Factors associated with outcomes of patients with primary sclerosing cholangitis and development and validation of a risk scoring system. Hepatology. 2019;69:2120–35. https://doi.org/10.1002/hep.30479.CrossRefPubMedPubMedCentral

11.

Bergquist A, Ekbom A, Olsson R, Kornfeldt D, Loof L, Danielsson A, et al. Hepatic and extrahepatic malignancies in primary sclerosing cholangitis. J Hepatol. 2002;36:321–7. https://doi.org/10.1016/s0168-8278(01)00288-4.CrossRefPubMed

12.

• Choi JG, Ghoz HM, Peeraphatdit T, Baichoo E, Addissie BD, Harmsen WS, et al. Aspirin use and the risk of cholangiocarcinoma. Hepatology. 2016;64:785–96. https://doi.org/10.1002/hep.28529This is an interesting case-control study showing that aspirin use might decrease the risk of cholangiocarcinoma.CrossRefPubMedPubMedCentral

13.

•• Bowlus CL, Lim JK, Lindor KD. AGA clinical practice update on surveillance for hepatobiliary cancers in patients with primary sclerosing cholangitis: expert review. Clin Gastroenterol Hepatol. 2019;17:2416–22. https://doi.org/10.1016/j.cgh.2019.07.011These manuscript provides practical guidelines for screening of hepatobiliary malignancies in primary sclerosing cholangitis. CrossRefPubMed

14.

Korc P, Sherman S. ERCP tissue sampling. Gastrointest Endosc. 2016;84:557–71. https://doi.org/10.1016/j.gie.2016.04.039.CrossRefPubMed

15.

Kipp BR, Stadheim LM, Halling SA, Pochron NL, Harmsen S, Nagorney DM, et al. A comparison of routine cytology and fluorescence in situ hybridization for the detection of malignant bile duct strictures. Am J Gastroenterol. 2004;99:1675–81. https://doi.org/10.1111/j.1572-0241.2004.30281.x.CrossRefPubMed

16.

Barr Fritcher EG, Voss JS, Brankley SM, Campion MB, Jenkins SM, Keeney ME, et al. An optimized set of fluorescence in situ hybridization probes for detection of Pancreatobiliary tract cancer in cytology brush samples. Gastroenterology. 2015;149:1813–24 e1. https://doi.org/10.1053/j.gastro.2015.08.046.CrossRefPubMed

17.

Smoczynski M, Jablonska A, Matyskiel A, Lakomy J, Dubowik M, Marek I, et al. Routine brush cytology and fluorescence in situ hybridization for assessment of pancreatobiliary strictures. Gastrointest Endosc. 2012;75:65–73. https://doi.org/10.1016/j.gie.2011.08.040.CrossRefPubMed

18.

Moreno Luna LE, Gores GJ. Advances in the diagnosis of cholangiocarcinoma in patients with primary sclerosing cholangitis. Liver Transpl. 2006;12:S15–9. https://doi.org/10.1002/lt.20938.CrossRefPubMed

19.

Moreno Luna LE, Kipp B, Halling KC, Sebo TJ, Kremers WK, Roberts LR, et al. Advanced cytologic techniques for the detection of malignant pancreatobiliary strictures. Gastroenterology. 2006;131:1064–72. https://doi.org/10.1053/j.gastro.2006.08.021.CrossRefPubMedPubMedCentral

20.

Bowlus CL, Olson KA, Gershwin ME. Evaluation of indeterminate biliary strictures. Nat Rev Gastroenterol Hepatol. 2016;13:28–37. https://doi.org/10.1038/nrgastro.2015.182.CrossRefPubMed

21.

Rosen CB, Heimbach JK, Gores GJ. Liver transplantation for cholangiocarcinoma. Transpl Int. 2010;23:692–7. https://doi.org/10.1111/j.1432-2277.2010.01108.x.CrossRefPubMed

22.

Chen YK. Preclinical characterization of the Spyglass peroral cholangiopancreatoscopy system for direct access, visualization, and biopsy. Gastrointest Endosc. 2007;65:303–11. https://doi.org/10.1016/j.gie.2006.07.048.CrossRefPubMed

23.

Pereira P, Peixoto A, Andrade P, Macedo G. Peroral cholangiopancreatoscopy with the SpyGlass(R) system: what do we know 10 years later. J Gastrointestin Liver Dis. 2017;26:165–70. https://doi.org/10.15403/jgld.2014.1121.262.cho.CrossRefPubMed

24.

Navaneethan U, Hasan MK, Lourdusamy V, Njei B, Varadarajulu S, Hawes RH. Single-operator cholangioscopy and targeted biopsies in the diagnosis of indeterminate biliary strictures: a systematic review. Gastrointest Endosc. 2015;82:608–14.e2. https://doi.org/10.1016/j.gie.2015.04.030.CrossRefPubMedPubMedCentral

25.

Nanda A, Brown JM, Berger SH, Lewis MM, Fritcher EGB, Gores GJ, et al. Triple modality testing by endoscopic retrograde cholangiopancreatography for the diagnosis of cholangiocarcinoma. Ther Adv Gastroenter. 2015;8:56–65. https://doi.org/10.1177/1756283x14564674.CrossRef

26.

Sun X, Zhou ZR, Tian JM, Wang ZQ, Huang QY, Fan KC, et al. Is single-operator peroral cholangioscopy a useful tool for the diagnosis of indeterminate biliary lesion? A systematic review and meta-analysis. Gastrointest Endosc. 2015;82:79–87. https://doi.org/10.1016/j.gie.2014.12.021.CrossRefPubMed

27.

Tischendorf JJW, Kruger M, Trautwein C, Duckstein N, Schneider A, Manns MP, et al. Cholangioscopic characterization of dominant bile duct stenoses in patients with primary sclerosing cholangitis. Endoscopy. 2006;38:665–9. https://doi.org/10.1055/s-2006-925257.CrossRefPubMed

28.

Siiki A, Rinta-Kiikka I, Koivisto T, Vasama K, Sand J, Laukkarinen J. Spyglass single-operator peroral cholangioscopy seems promising in the evaluation of primary sclerosing cholangitis-related biliary strictures. Scand J Gastroenterol. 2014;49:1385–90. https://doi.org/10.3109/00365521.2014.940376.CrossRefPubMed

29.

Liu R, Cox Rn K, Siddiqui A, Feurer M, Baron T, Adler DG. Peroral cholangioscopy facilitates targeted tissue acquisition in patients with suspected cholangiocarcinoma. Minerva Gastroenterol Dietol. 2014;60:127–33.PubMed

30.

Rey JW, Hansen T, Dumcke S, Tresch A, Kramer K, Galle PR, et al. Efficacy of SpyGlass(TM)-directed biopsy compared to brush cytology in obtaining adequate tissue for diagnosis in patients with biliary strictures. World J Gastrointest Endosc. 2014;6:137–43. https://doi.org/10.4253/wjge.v6.i4.137.CrossRefPubMedPubMedCentral

31.

Arnelo U, von Seth E, Bergquist A. Prospective evaluation of the clinical utility of single-operator peroral cholangioscopy in patients with primary sclerosing cholangitis. Endoscopy. 2015;47:696–702. https://doi.org/10.1055/s-0034-1391845.CrossRefPubMed

32.

• Njei B, TR MC, Varadarajulu S, Navaneethan U. Systematic review with meta-analysis: endoscopic retrograde cholangiopancreatography-based modalities for the diagnosis of cholangiocarcinoma in primary sclerosing cholangitis. Aliment Pharmacol Ther. 2016;44:1139–51. https://doi.org/10.1111/apt.13817This is the largest meta-analysis indicating that single-operator cholangioscopy with targeted biopsies seems to be the most precise ERCP-based modality for cholangiocarcinoma diagnosing compared to the other modalities in primary sclerosing cholangitis. CrossRefPubMed

33.

•• Majeed A, Castedal M, Arnelo U, Soderdahl G, Bergquist A, Said K. Optimizing the detection of biliary dysplasia in primary sclerosing cholangitis before liver transplantation. Scand J Gastroenterol. 2018;53:56–63. https://doi.org/10.1080/00365521.2017.1385840This is the largest study showing that single-operator cholangioscopy for targeted examination at the second ERCP significantly improved sensitivity and specificity.CrossRefPubMed

34.

Kaura K, Sawas T, Bazerbachi F, Storm AC, Martin JA, Gores GJ, et al. Cholangioscopy biopsies improve detection of cholangiocarcinoma when combined with cytology and FISH, but not in patients with PSC. Dig Dis Sci. 2019:1–8. https://doi.org/10.1007/s10620-019-05866-2.CrossRef

35.

Sandha G, D'Souza P, Halloran B, Montano-Loza AJ. A cholangioscopy-based novel classification system for the phenotypic stratification of dominant bile duct strictures in primary sclerosing cholangitis-the Edmonton Classification. J Can Assoc Gastroenterol. 2018;1:174–80. https://doi.org/10.1093/jcag/gwy020.CrossRefPubMedPubMedCentral

36.

Awadallah NS, Chen YK, Piraka C, Antillon MR, Shah RJ. Is there a role for cholangioscopy in patients with primary sclerosing cholangitis? Am J Gastroenterol. 2006;101:284–91. https://doi.org/10.1111/j.1572-0241.2006.00383.x.CrossRefPubMed

37.

Korrapati P, Ciolino J, Wani S, Shah J, Watson R, Muthusamy VR, et al. The efficacy of peroral cholangioscopy for difficult bile duct stones and indeterminate strictures: a systematic review and meta-analysis. Endosc Int Open. 2016;4:E263–75. https://doi.org/10.1055/s-0042-100194.CrossRefPubMedPubMedCentral

38.

de Vries AB, van der Heide F, Ter Steege RWF, Koornstra JJ, Buddingh KT, Gouw ASH, et al. Limited diagnostic accuracy and clinical impact of single-operator peroral cholangioscopy for indeterminate biliary strictures. Endoscopy. 2019. https://doi.org/10.1055/a-1061-7067.CrossRef

39.

Azeem N, Gostout CJ, Knipschield M, Baron TH. Cholangioscopy with narrow-band imaging in patients with primary sclerosing cholangitis undergoing ERCP. Gastrointest Endosc. 2014;79:773–9 e2. https://doi.org/10.1016/j.gie.2013.09.017.CrossRefPubMed

40.

Nakazawa T, Naitoh I, Hayashi K, Miyabe K, Simizu S, Joh T. Diagnosis of IgG4-related sclerosing cholangitis. World J Gastroenterol. 2013;19:7661–70. https://doi.org/10.3748/wjg.v19.i43.7661.CrossRefPubMedPubMedCentral

41.

Kalaitzakis E, Sturgess R, Kaltsidis H, Oppong K, Lekharaju V, Bergenzaun P, et al. Diagnostic utility of single-user peroral cholangioscopy in sclerosing cholangitis. Scand J Gastroenterol. 2014;49:1237–44. https://doi.org/10.3109/00365521.2014.936032.CrossRefPubMed

42.

Tischendorf JJW, Hecker H, Kruger M, Manns MP, Meier PN. Characterization, outcome, and prognosis in 273 patients with primary sclerosing cholangitis: a single center study. Am J Gastroenterol. 2007;102:107–14. https://doi.org/10.1111/j.1572-0241.2006.00872.x.CrossRefPubMed

43.

Chapman MH, Webster GJ, Bannoo S, Johnson GJ, Wittmann J, Pereira SP. Cholangiocarcinoma and dominant strictures in patients with primary sclerosing cholangitis: a 25-year single-centre experience. Eur J Gastroenterol Hepatol. 2012;24:1051–8. https://doi.org/10.1097/MEG.0b013e3283554bbf.CrossRefPubMedPubMedCentral

44.

Ponsioen CY, Arnelo U, Bergquist A, Rauws EA, Paulsen V, Cantu P, et al. No superiority of stents vs balloon dilatation for dominant strictures in patients with primary Sclerosing cholangitis. Gastroenterology. 2018;155:752–9. https://doi.org/10.1053/j.gastro.2018.05.034.CrossRefPubMed

45.

^• Aabakken L, Karlsen TH, Albert J, Arvanitakis M, Chazouilleres O, Dumonceau J-M, et al. Role of endoscopy in primary sclerosing cholangitis: European Society of Gastrointestinal Endoscopy (ESGE) and European Association for the Study of the Liver (EASL) clinical guideline. J Hepatol 2017;66:1265-81 doi:101016/jjhep201702013. This review summarizes the current role of endoscopy in patients with primary sclerosing cholangitis.

46.

Chapman MH, Thorburn D, Hirschfield GM, Webster GGJ, Rushbrook SM, Alexander G, et al. British Society of Gastroenterology and UK-PSC guidelines for the diagnosis and management of primary sclerosing cholangitis. Gut. 2019;68:1356–78. https://doi.org/10.1136/gutjnl-2018-317993.CrossRefPubMedPubMedCentral

47.

Baluyut AR, Sherman S, Lehman GA, Hoen H, Chalasani N. Impact of endoscopic therapy on the survival of patients with primary sclerosing cholangitis. Gastrointest Endosc. 2001;53:308–12. https://doi.org/10.1067/mge.2001.112739.CrossRefPubMed

48.

Gluck M, Cantone NR, Brandabur JJ, Patterson DJ, Bredfeldt JE, Kozarek RA. A twenty-year experience with endoscopic therapy for symptomatic primary sclerosing cholangitis. J Clin Gastroenterol. 2008;42:1032–9. https://doi.org/10.1097/MCG.0b013e3181646713.CrossRefPubMed

49.

Rupp C, Hippchen T, Bruckner T, Kloters-Plachky P, Schaible A, Koschny R, et al. Effect of scheduled endoscopic dilatation of dominant strictures on outcome in patients with primary sclerosing cholangitis. Gut. 2019;68:2170–8. https://doi.org/10.1136/gutjnl-2018-316801.CrossRefPubMedPubMedCentral

50.

Dodd GD 3rd, Niedzwiecki GA, Campbell WL, Baron RL. Bile duct calculi in patients with primary sclerosing cholangitis. Radiology. 1997;203:443–7. https://doi.org/10.1148/radiology.203.2.9114102.CrossRefPubMed

51.

Sejpal DV, Trindade AJ, Lee C, Miller LS, Benias PC, Inamdar S, et al. Digital cholangioscopy can detect residual biliary stones missed by occlusion cholangiogram in ERCP: a prospective tandem study. Endosc Int Open. 2019;7:E608–E14. https://doi.org/10.1055/a-0842-6450.CrossRefPubMedPubMedCentral

52.

Sethi A, Chen YK, Austin GL, Brown WR, Brauer BC, Fukami NN, et al. ERCP with cholangiopancreatoscopy may be associated with higher rates of complications than ERCP alone: a single-center experience. Gastrointest Endosc. 2011;73:251–6. https://doi.org/10.1016/j.gie.2010.08.058.CrossRefPubMed

53.

Othman MO, Guerrero R, Elhanafi S, Davis B, Hernandez J, Houle J, et al. A prospective study of the risk of bacteremia in directed cholangioscopic examination of the common bile duct. Gastrointest Endosc. 2016;83:151–7. https://doi.org/10.1016/j.gie.2015.05.018.CrossRefPubMed

54.

Peiseler M, Reiners D, Pinnschmidt HO, Sebode M, Jung F, Hartl J, et al. Risk of endoscopic biliary interventions in primary sclerosing cholangitis is similar between patients with and without cirrhosis. PLoS One. 2018;13:e0202686. https://doi.org/10.1371/journal.pone.0202686.CrossRefPubMedPubMedCentral

55.

Khashab MA, Chithadi KV, Acosta RD, Bruining DH, Chandrasekhara V, Eloubeidi MA, et al. Antibiotic prophylaxis for GI endoscopy. Gastrointest Endosc. 2015;81:81–9. https://doi.org/10.1016/j.gie.2014.08.008.CrossRefPubMed

56.

Ponsioen CY, Reitsma JB, Boberg KM, Aabakken L, Rauws EA, Schrumpf E. Validation of a cholangiographic prognostic model in primary sclerosing cholangitis. Endoscopy. 2010;42:742–7. https://doi.org/10.1055/s-0030-1255527.CrossRefPubMed

57.

Robles-Medranda C, Valero M, Soria-Alcivar M, Puga-Tejada M, Oleas R, Ospina-Arboleda J, et al. Reliability and accuracy of a novel classification system using peroral cholangioscopy for the diagnosis of bile duct lesions. Endoscopy. 2018;50:1059–70. https://doi.org/10.1055/a-0607-2534.CrossRefPubMed

58.

Boyd S, Vannas M, Jokelainen K, Isoniemi H, Makisalo H, Farkkila MA, et al. Suspicious brush cytology is an indication for liver transplantation evaluation in primary sclerosing cholangitis. World J Gastroenterol. 2017;23:6147–54. https://doi.org/10.3748/wjg.v23.i33.6147.CrossRefPubMedPubMedCentral

Titel: The Role of Cholangioscopy in the Management of Primary Sclerosing Cholangitis
verfasst von: Aldo J. Montano-Loza
Maryam Ebadi
Gurpal Sandha
Publikationsdatum: 21.04.2020
Verlag: Springer US
Erschienen in: Current Hepatology Reports / Ausgabe 2/2020
Elektronische ISSN: 2195-9595
DOI: https://doi.org/10.1007/s11901-020-00514-0

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

23.04.2024 | Ablationstherapie | Nachrichten

Update Innere Medizin

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

Newsletter bestellen

Live-Webinar: Aktuelle Leitlinien bei Herz-Kreislauf-Erkrankungen

Springer Medizin

The Role of Cholangioscopy in the Management of Primary Sclerosing Cholangitis

Abstract

Purpose of Review

Recent Findings

Summary

Leitlinien kompakt für die Innere Medizin

Neu im Fachgebiet Innere Medizin

Wie erfolgreich ist eine Re-Ablation nach Rezidiv?

Europäische Ernährungsgewohnheiten: Das sind die häufigsten Fehler

Hinter dieser Appendizitis steckte ein Erreger

Demenzkranke durch Antipsychotika vielfach gefährdet

Update Innere Medizin

Live-Webinar: Aktuelle Leitlinien bei Herz-Kreislauf-Erkrankungen

Springer Medizin

Abstract

Purpose of Review

Recent Findings

Summary

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

Weitere Artikel der Ausgabe 2/2020

Therapeutic and Prophylactic Anticoagulation in Cirrhosis Patients

Sarcopenia in Liver Transplantation: an Update

Newer Approaches to the Management of Pruritus in Cholestatic Liver Disease

Mechanisms of Fibrosis in Primary Biliary Cholangitis

PSC and Overlap Syndromes

Do Nutritional Interventions Improve the Outcomes of Patients with Cirrhosis and Ascites: a Systematic Review of Randomized Trials

Leitlinien kompakt für die Innere Medizin

Neu im Fachgebiet Innere Medizin

Wie erfolgreich ist eine Re-Ablation nach Rezidiv?

Europäische Ernährungsgewohnheiten: Das sind die häufigsten Fehler

Hinter dieser Appendizitis steckte ein Erreger

Demenzkranke durch Antipsychotika vielfach gefährdet

Update Innere Medizin