eMedicine Specialties > Radiology > Gastrointestinal

Cholangitis, Primary Sclerosing: Follow-up

Author: Ali Nawaz Khan, MBBS, FRCS, FRCP, FRCR, LRCP, Chairman of Medical Imaging, Professor of Radiology, NGHA, King Fahad National Guard Hospital, King Abdulaziz Medical City, Riyadh, Saudi Arabia
Coauthor(s): Sumaira MacDonald, MBChB, PhD, MRCP, FRCR, Lecturer, Sheffield University Medical School; Endovascular Fellow, Sheffield Vascular Institute; Aali J Sheen, MBChB, FRCS, Specialist Registrar, Department of HPB Surgery, Manchester Royal Infirmary Oxford Road Manchester UK
Contributor Information and Disclosures

Updated: Jan 4, 2008

Intervention

Patients with CBD strictures presenting with recurrent attacks of cholangitis can derive short-term benefit from endoscopic or percutaneous balloon dilatation. Many of these patients have pigment stone impaction at the site of the stricture. With successful placement of a guidewire across the stricture balloon, dilatation is usually straightforward. Although this results in the immediate relief of symptoms, the long-term benefit of stricture dilatation is unclear.24,25,26

Medicolegal Pitfalls

  • Every effort should be made not to introduce infection with endoscopic manipulation. For similar reasons, sphincterotomy and the introduction of stents in strictures secondary to PSC should be used sparingly.
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More on Cholangitis, Primary Sclerosing

Overview: Cholangitis, Primary Sclerosing
Imaging: Cholangitis, Primary Sclerosing
Follow-up: Cholangitis, Primary Sclerosing
Multimedia: Cholangitis, Primary Sclerosing
References
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References

  1. Burak KW, Urbanski SJ, Swain MG. A case of coexisting primary biliary cirrhosis and primary sclerosing cholangitis: a new overlap of autoimmune liver diseases. Dig Dis Sci. Sep 2001;46(9):2043-7. [Medline].

  2. Cameron RG, Blendis LM, Neuman MG. Accumulation of macrophages in primary sclerosing cholangitis. Clin Biochem. May 2001;34(3):195-201. [Medline].

  3. Hawkes ND, Mutimer D, Thomas GA. Intermittent jaundice and rigors in a patient with longstanding ulcerative colitis. Postgrad Med J. Jun 2001;77(908):406-7, 412-3. [Medline].

  4. Schrumpf E, Boberg KM. Primary sclerosing cholangitis: challenges of a new millenium. Dig Liver Dis. Dec 2000;32(9):753-5. [Medline].

  5. Lazaridis KN. Dissecting the genetic susceptibility for cholangiocarcinoma in primary sclerosing cholangitis. Hepatology. Jan 2008;47(1):8-10. [Medline].

  6. Dahnart W. Radiology Review Manual. 6th. Phildelphia: Lippincott William & Wilkins; 2007:699-700.

  7. Takikawa H. Characteristics of primary sclerosing cholangitis in Japan. Hepatol Res. Oct 2007;37 Suppl 3:S470-3. [Medline].

  8. Wiesner RH. Liver transplantation for primary sclerosing cholangitis: timing, outcome, impact of inflammatory bowel disease and recurrence of disease. Best Pract Res Clin Gastroenterol. Aug 2001;15(4):667-80. [Medline].

  9. Freeman K, Shao Z, Remzi FH, Lopez R, Fazio VW, Shen B. Impact of orthotopic liver transplant for primary sclerosing cholangitis on chronic antibiotic refractory pouchitis. Clin Gastroenterol Hepatol. Jan 2008;6(1):62-8. [Medline].

  10. Takagi I, Shibamoto Y, Toda G. [Primary sclerosing cholangitis (PSC)]. Ryoikibetsu Shokogun Shirizu. 2000;(31):226-9. [Medline].

  11. Oikarinen H, Paakko E, Suramo I, et al. Imaging and estimation of the prognostic features of primary sclerosing cholangitis by ultrasonography and MR cholangiography. Acta Radiol. Jul 2001;42(4):403-8. [Medline].

  12. Haider MA, Bret PM. The role of magnetic resonance cholangiography in primary sclerosing cholangitis. J Hepatol. Oct 2000;33(4):659-60. [Medline].

  13. Bjornsson ES, Kilander AF, Olsson RG. Bile duct bacterial isolates in primary sclerosing cholangitis and certain other forms of cholestasis--a study of bile cultures from ERCP. Hepatogastroenterology. Nov-Dec 2000;47(36):1504-8. [Medline].

  14. Goolamali SI, Taylor-Robinson SD. Endoscopic retrograde cholangiopancreatography appearances of early primary sclerosing cholangitis. J Clin Gastroenterol. May-Jun 2001;32(5):460-1. [Medline].

  15. Keogan MT, Edelman RR. Technologic advances in abdominal MR imaging. Radiology. Aug 2001;220(2):310-20. [Medline].

  16. Rajaram R, Ponsioen CY, Majoie CB, et al. Evaluation of a modified cholangiographic classification system for primary sclerosing cholangitis. Abdom Imaging. Jan-Feb 2001;26(1):43-7. [Medline].

  17. van den Hazel SJ, Wolfhagen EH, van Buuren HR, et al. Prospective risk assessment of endoscopic retrograde cholangiography in patients with primary sclerosing cholangitis. Dutch PSC Study Group. Endoscopy. Oct 2000;32(10):779-82. [Medline].

  18. Etzel JP, Eng SC, Ko CW, Lee SD, Saunders MD, Tung BY. Complications after ERCP in patients with primary sclerosing cholangitis. Gastrointest Endosc. Nov 30 2007;[Medline].

  19. Hirche TO, Russler J, Braden B, Schuessler G, Zeuzem S, Wehrmann T. Sonographic detection of perihepatic lymphadenopathy is an indicator for primary sclerosing cholangitis in patients with inflammatory bowel disease. Int J Colorectal Dis. Nov 2004;19(6):586-94. [Medline].

  20. Johnson KJ, Olliff JF, Olliff SP. The presence and significance of lymphadenopathy detected by CT in primary sclerosing cholangitis. Br J Radiol. Dec 1998;71(852):1279-82. [Medline].

  21. Fulcher AS, Turner MA, Franklin KJ, et al. Primary sclerosing cholangitis: evaluation with MR cholangiography-a case-control study. Radiology. Apr 2000;215(1):71-80. [Medline].

  22. Elsayes KM, Oliveira EP, Narra VR, Abou El Abbass HA, Ahmed MI, Tongdee R. MR and MRCP in the evaluation of primary sclerosing cholangitis: current applications and imaging findings. J Comput Assist Tomogr. May-Jun 2006;30(3):398-404. [Medline].

  23. Jonas E, Hultcrantz R, Slezak P, et al. Dynamic 99Tcm-HIDA SPET: non-invasive measuring of intrahepatic bile flow. Description of the method and a study in primary sclerosing cholangitis. Nucl Med Commun. Feb 2001;22(2):127-34. [Medline].

  24. Kaya M, Petersen BT, Angulo P, et al. Balloon dilation compared to stenting of dominant strictures in primary sclerosing cholangitis. Am J Gastroenterol. Apr 2001;96(4):1059-66. [Medline].

  25. Linder S, Soderlund C. Endoscopic therapy in primary sclerosing cholangitis: outcome of treatment and risk of cancer. Hepatogastroenterology. Mar-Apr 2001;48(38):387-92. [Medline].

  26. Lopez RR Jr, Cosenza CA, Lois J, et al. Long-term results of metallic stents for benign biliary strictures. Arch Surg. Jun 2001;136(6):664-9. [Medline].

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Further Reading

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Keywords

PSC, primary sclerosing cholangitis, cholangitis, bile duct stricture, fibrosis of the bile duct, jaundice,  biliary cirrhosis, inflammatory bowel disease, liver transplantation, gallbladder disease, pancreatitis

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Contributor Information and Disclosures

Author

Ali Nawaz Khan, MBBS, FRCS, FRCP, FRCR, LRCP, Chairman of Medical Imaging, Professor of Radiology, NGHA, King Fahad National Guard Hospital, King Abdulaziz Medical City, Riyadh, Saudi Arabia
Ali Nawaz Khan, MBBS, FRCS, FRCP, FRCR, LRCP is a member of the following medical societies: American Institute of Ultrasound in Medicine, Radiological Society of North America, Royal College of Physicians, Royal College of Physicians and Surgeons of the United States, Royal College of Radiologists, and Royal College of Surgeons of England
Disclosure: Nothing to disclose.

Coauthor(s)

Sumaira MacDonald, MBChB, PhD, MRCP, FRCR, Lecturer, Sheffield University Medical School; Endovascular Fellow, Sheffield Vascular Institute
Sumaira MacDonald, MBChB, PhD, MRCP, FRCR is a member of the following medical societies: British Medical Association, Royal College of Physicians, and Royal College of Radiologists
Disclosure: Nothing to disclose.

Aali J Sheen, MBChB, FRCS, Specialist Registrar, Department of HPB Surgery, Manchester Royal Infirmary Oxford Road Manchester UK
Aali J Sheen, MBChB, FRCS is a member of the following medical societies: Royal College of Surgeons of England
Disclosure: Nothing to disclose.

Medical Editor

Eric P Weinberg, MD, Associate Professor, Department of Radiology, University of Rochester Medical Center, Strong Memorial Hospital
Eric P Weinberg, MD is a member of the following medical societies: American College of Radiology, American Roentgen Ray Society, and Radiological Society of North America
Disclosure: Nothing to disclose.

Pharmacy Editor

Bernard D Coombs, MB, ChB, PhD, Consulting Staff, Department of Specialist Rehabilitation Services, Hutt Valley District Health Board, New Zealand
Disclosure: Nothing to disclose.

Managing Editor

Arnold C Friedman, MD, FACR, Associate Chairman, Department of Radiology, University of Florida Health Science Center; Chief, Department of Radiology, Shands-Jacksonville Hospital
Arnold C Friedman, MD, FACR is a member of the following medical societies: American College of Radiology, American Institute of Ultrasound in Medicine, American Roentgen Ray Society, Association of University Radiologists, and Radiological Society of North America
Disclosure: Nothing to disclose.

CME Editor

Robert M Krasny, MD, Consulting Staff, Department of Radiology, The Angeles Clinic and Research Institute
Robert M Krasny, MD is a member of the following medical societies: American Roentgen Ray Society and Radiological Society of North America
Disclosure: Nothing to disclose.

Chief Editor

John Karani, MBBS, FRCR, Consulting Staff, Department of Radiology, King's College Hospital, London
Disclosure: Nothing to disclose.

 
 
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