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Eur J Gastroenterol Hepatol. 2012 Sep;24(9):1051-8. doi: 10.1097/MEG.0b013e3283554bbf.

Cholangiocarcinoma and dominant strictures in patients with primary sclerosing cholangitis: a 25-year single-centre experience.

Author information

1
Division of GI Services, University College London Hospitals NHS Foundation Trust, London, UK.

Abstract

BACKGROUND:

Dominant biliary strictures occur commonly in patients with primary sclerosing cholangitis (PSC), who have a high risk of developing cholangiocarcinoma (CC). The natural history and optimal management of dominant strictures remain unclear, with some reports suggesting that endoscopic interventions improve outcome.

METHODS:

We describe a 25-year experience in patients with PSC-related dominant strictures at a single tertiary referral centre.

RESULTS:

A total of 128 patients with PSC (64% men, mean age at referral 49 years) were followed for a mean of 9.8 years. Eighty patients (62.5%) with dominant biliary strictures had a median of 3 (range 0-34) interventions, compared with 0 (0-7) in the 48 patients without dominant strictures (P<0.001). Endoscopic interventions included the following: (i) stenting alone (46%), (ii) dilatation alone (20%), (iii) dilatation and stenting (17%) and (iv) none or failed intervention (17%, of whom most required percutaneous transhepatic drainage). The major complication rate for endoscopic retrograde cholangiopancreatography was low (1%). The mean survival of those with dominant strictures (13.7 years) was worse than that for those without dominant strictures (23 years), with much of the survival difference related to a 26% risk of CC developing only in those with dominant strictures. Half of those with CC presented within 4 months of the diagnosis of PSC, highlighting the importance of a thorough evaluation of new dominant strictures.

CONCLUSION:

Repeated endoscopic therapy in PSC patients is safe, but the prognosis remains worse in the subgroup with dominant strictures. In our series, dominant strictures were associated with a high risk of developing CC.

PMID:
22653260
PMCID:
PMC3584158
DOI:
10.1097/MEG.0b013e3283554bbf
[Indexed for MEDLINE]
Free PMC Article

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