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Gastrointest Endosc. 2008 Dec;68(6):1204-8. doi: 10.1016/j.gie.2008.08.013.

Differentiating sclerosing cholangitis caused by autoimmune pancreatitis and primary sclerosing cholangitis according to endoscopic duodenal papillary features.

Author information

1
Division of Gastroenterology, Yokohama Rosai Hospital, Yokohama City University, Graduate School of Medicine, Kanazawa, Yokohama, Japan.

Abstract

BACKGROUND:

Differentiating primary sclerosing cholangitis (PSC) and sclerosing cholangitis caused by autoimmune pancreatitis (SC-AIP) is often challenging. Recently, endoscopic findings of the duodenal papilla in cases with AIP or PSC were reported by Unno and Parlak, although the endoscopic differentiation of these 2 conditions has not yet been fully clarified.

OBJECTIVE:

Our purpose was to clarify the endoscopic findings of the duodenal papilla in patients with SC-AIP and those with PSC and to determine criteria for the differentiation of these conditions.

DESIGN:

Case series.

SETTING:

Retrospective.

PATIENTS:

Twenty-seven patients with SC-AIP and 12 patients with PSC who had undergone ERCP were identified from our database. We reviewed these records to determine whether the duodenal papillary findings (swollen papilla/normal papilla/small papilla) might be potentially useful for differentiating SC-AIP and PSC. Immunohistopathological findings for the duodenal papilla were also examined by using immunoglobulin G4 (IgG4) among the infiltrating plasma cells.

INTERVENTIONS:

ERCP, biopsy specimen taken from duodenal papilla.

MAIN OUTCOME MEASUREMENTS:

The presence of a swollen duodenal papilla with IgG4-positive plasma cells was useful for discriminating SC-AIP from with PSC.

RESULTS:

A swollen duodenal papilla was observed in 63% (17/27) of the patients with SC-AIP, whereas there was no swelling of the duodenal papilla of the patients with PSC. A small papilla was recognized in 50% (6/12) of the patients with PSC. IgG4-positive plasma cells in the duodenal papilla were significantly detected in the patients with SC-AIP but not in the patients with PSC.

LIMITATION:

Single-center study.

CONCLUSIONS:

Characteristic duodenal endoscopic papillary features in patients with SC-AIP, such as a swollen duodenal papilla and positive immunostaining for IgG4, might be helpful for discriminating this condition from PSC.

PMID:
19028233
DOI:
10.1016/j.gie.2008.08.013
[Indexed for MEDLINE]

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