Clinical Endoscopy

Stent versus Balloon Dilation for the Treatment of Dominant Strictures in Primary Sclerosing Cholangitis: A Systematic Review and Meta-Analysis: Marina Tucci Gammaro Baldavira Ferreira, Igor Braga Ribeiro, Diogo Turiani Hourneaux de Moura, Thomas R. McCarty, Alberto Machado da Ponte Neto, Galileu Ferreira Ayala Farias, Antônio Afonso de Miranda Neto, Pedro Victor Aniz Gomes de Oliveira, Wanderley Marques Bernardo, Eduardo Guimarães Hourneaux de Moura; Clin Endosc 2021;54(6):833-842. Published online July 1, 2021; DOI: https://doi.org/10.5946/ce.2021.052

Background
/Aims: The endoscopic management of primary sclerosing cholangitis (PSC)-associated dominant strictures remains challenging. This systematic review and meta-analysis aimed to compare balloon dilation and stent placement in the treatment of dominant strictures among PSC patients.
Methods
Literature searches on MEDLINE, EMBASE, Cochrane CENTRAL and Lilacs/Bireme were performed for studies published until December 2020. Measured outcomes included clinical efficacy, stricture recurrence, cumulative recurrencefree rate, transplant rate, 5-year survival rate, and adverse events (i.e., pancreatitis, cholangitis, bleeding, perforation and death).
Results
A total of 5 studies (n=467) were included. Based on pooled analyses, there were no differences in clinical efficacy (risk difference [RD], -0.13; 95% confidence interval [CI], -0.58 to 0.33; I²=93%) or transplant rates (RD, -0.09; 95% CI, -0.19 to 0.01; I²=0%); however, the risk of occurrence of adverse events was lower with balloon dilatation than with stent placement (RD,-0.34; 95% CI, -0.45 to -0.23; I²=61%). Among the types of adverse events reported, only the rates of cholangitis/bacteremia were significantly lower in balloon dilation patients (RD, -0.19; 95% CI, -0.25 to -0.13; I²=51%).
Conclusions
Compared to balloon dilation, stent placement for dominant strictures in PSC appeared to have higher complication rates without significant differences in efficacy.

Citations

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Michael P. Manns, Annika Bergquist, Tom H. Karlsen, Cynthia Levy, Andrew J. Muir, Cyriel Ponsioen, Michael Trauner, Grace Wong, Zobair M. Younossi
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Endoscopic management of primary sclerosing cholangitis
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Treatment of Non-Anastomotic Biliary Strictures after Liver Transplantation: How Effective Is Our Current Treatment Strategy?
Florian A. Michael, Mireen Friedrich-Rust, Hans-Peter Erasmus, Christiana Graf, Olivier Ballo, Mate Knabe, Dirk Walter, Christoph D. Steup, Marcus M. Mücke, Victoria T. Mücke, Kai H. Peiffer, Esra Görgülü, Antonia Mondorf, Wolf O. Bechstein, Natalie Filma
Journal of Clinical Medicine.2023; 12(10): 3491. CrossRef
Treatment of primary sclerosing cholangitis combined with inflammatory bowel disease
You Sun Kim, Edward H. Hurley, Yoojeong Park, Sungjin Ko
Intestinal Research.2023; 21(4): 420. CrossRef
Liver Transplantation for Primary Sclerosing Cholangitis (PSC) With or Without Inflammatory Bowel Disease (IBD)—A European Society of Organ Transplantation (ESOT) Consensus Statement
M. Carbone, A. Della Penna, C. Mazzarelli, E. De Martin, C. Villard, A. Bergquist, P. D. Line, J. M. Neuberger, S. Al-Shakhshir, P. J. Trivedi, U. Baumann, L. Cristoferi, J. Hov, B. Fischler, N. H. Hadzic, D. Debray, L. D’Antiga, N. Selzner, L. S. Belli,
Transplant International.2023;[Epub] CrossRef
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Biomedicines.2022; 10(6): 1288. CrossRef
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Jesús García-Cano, Eva de la Santa Belda, Francisco Domper
Revista Española de Enfermedades Digestivas.2022;[Epub] CrossRef
Endoscopic stenting of dominant strictures in patients with primary sclerosing cholangitis: When, how, and for how long?
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Endoscopy International Open.2022; 10(09): E1169. CrossRef

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Role of Endoscopy in Primary Sclerosing Cholangitis: Purnima Bhat, Lars Aabakken; Clin Endosc 2021;54(2):193-201. Published online May 8, 2020; DOI: https://doi.org/10.5946/ce.2020.019-IDEN

Abstract PDF PubReader ePub

Primary sclerosing cholangitis (PSC) is a progressive disease of the bile ducts that usually results in chronic liver disease often requiring liver transplantation. Endoscopy remains crucial to the care of these patients, although magnetic resonance cholangiopancreatography has replaced endoscopic retrograde cholangiopancreatography (ERCP) as the primary imaging modality for diagnosis. For detection of dysplasia or cholangiocarcinoma, ERCP with intraductal sampling remains compulsory. Moreover, dominant strictures play an important part in the disease development, and management by balloon dilatation or stenting could contribute to long-term prognosis. In addition, endoscopy offers management for adverse events such as bile leaks and anastomotic strictures after liver transplantation. Finally, the special phenotype of inflammatory bowel disease associated with PSC as well as the frequent occurrence of portal hypertension mandates close follow-up with colonoscopy and upper endoscopy. With the emergence of novel techniques, the endoscopist remains a key member of the multidisciplinary team caring for PSC patients.

Citations

Citations to this article as recorded by

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Michael P. Manns, Annika Bergquist, Tom H. Karlsen, Cynthia Levy, Andrew J. Muir, Cyriel Ponsioen, Michael Trauner, Grace Wong, Zobair M. Younossi
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Clinical management of autoimmune liver diseases: juncture, opportunities, and challenges ahead
Yangfan Chen, Ruofei Chen, Haiyan Li, Zongwen Shuai
Immunologic Research.2025;[Epub] CrossRef
The additional value of the combined use of EUS and ERCP for the evaluation of unclear biliary strictures
Eszter Bényei, Antonio Molinaro, Per Hedenström, Riadh Sadik
Scandinavian Journal of Gastroenterology.2024; 59(8): 980. CrossRef
Bilothorax as an endoscopic retrograde cholangiopancreatography complication and a review of the literature
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Clinical Liver Disease.2022; 20(S1): 21. CrossRef

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Three Cases of Autoimmune Pancreatitis: Won Jae Yoon, M.D., Yong-Tae Kim, M.D., Yong Bum Yoon, M.D., Ji Kon Ryu, M.D., Jin-Hyeok Hwang, M.D., Hyoun Woo Kang, M.D., Su Hwan Kim, M.D., Jin Hyun Kim, M.D., Sun Whe Kim, M.D.*, Woo Ho Kim, M.D.^†, Byung Ihn Choi, M.D.^‡ and Ji Bo; Korean J Gastrointest Endosc 2004;28(1):52-59. Published online January 30, 2004

Abstract PDF: Autoimmune pancreatitis is a distinct entity with characteristic histologic, morphologic, and clinical features. It may be isolated or associated with Sjögren syndrome, primary biliary cirrhosis, primary sclerosing cholangitis, Crohn's disease and ulcerative colitis, or other immune-mediated disorders. Recent studies have reported the profiles of autoantibodies in autoimmune pancreatitis. Also a number of reports on single cases or small series of cases have been published. We report three cases of autoimmune pancreatitis; one case was associated with primary sclerosing cholangitis, which was misdiagnosed as pancreatic cancer; the other two cases were improved with steroid therapy. (Korean J Gastrointest Endosc 2004;28:52⁣59)

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70세 남자, 황달: Korean J Gastrointest Endosc 2003;26(5):315-316. Published online May 30, 2003

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A Case of Primary Sclerosing Cholangitis Localized at Intrahepatic Bile Duct: Woon Hyun Jun, M.D., Ho Soon Choi, M.D., Seok Woo Kang, M.D., Yun Ju Cho, M.D.,Oh Young Lee, M.D., Dong Soo Han, M.D., Yong Chul Jun, M.D., Bung Chul Yoon, M.D.,Joon Soo Hahm, M.D., Min Ho Lee, M.D., Chun Suhk Khee, M.D. and Kyung Nam Park, M.D.; Korean J Gastrointest Endosc 2001;22(4):250-254. Published online April 30, 2001

Abstract PDF: Primary sclerosing cholangitis is a cholestatic liver disease characterized by fibroobliterative inflammation of the entire biliary tree. It is a slowly progressive disease with an undulating course, resulting in biliary cirrhosis. The gold standard for establishing the diagnosis is cholangiographic demonstration of typical diffuse biliary stricturing and beading. We exprienced a case of primary sclerosing cholangitis by Endoscopic retrograde cholangiopancreatography (ERCP) demonstration. ERCP findings revealed multiple luminal narrowing, stricture and beaded dilatation of the intrahepatic duct. We report a case of primary sclerosing cholangitis localizing at intrahepatic bile duct, which is confused with cholangiocarcinoma. (Korean J Gastrointest Endosc 2001; 22:250⁣254)

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증례 : 담도 췌장 ; 원발성 경화성 담관염 환자에서 MR Cholangiography 와 CT Cholangiography 의 임상적 유용성 ( Case Reports : Biliary Tract & Pancreas ; Clinical Usefulness of Magnetic Resonance Cholangiagraphy and Computed Tomography Cholangiography in Primary Sclerosing Cholangitis ): Korean J Gastrointest Endosc 1997;17(5):716-722. Published online November 30, 1996

Abstract PDF: Primary sclerosing cholangitis(PSC) is rare disease which is characterized by inflammation and obliteration of bile duct leading to biliary cirrhosis and liver failure. The cause of PSC is unknown although a number of potential etiologic factor have been investigated. The diagonsis is confirmed by typical cholangiographic demonstration with clinical features. On endoscopic retrograde cholangiopancreatography(ERCP), multifocal strictures involving both intra and extrahepatic bile ducts are most common; they were diffusely distributed, short, and annular, alternating with normal or slightly dilated segments to produce a "beaded" appearance, the "pruned-tree" appearance due to diminished arborization of the intrahepatic duct, band-like stricture, and diverticular-like outpouching(s) are seen occasionally on cholangiography, and the report of primary sclerosing cholangitis in Korea is being increased due to increased use of ERCP. Recently, magnetic resonance cholangiography(MR cholangiography) and computed tomography cholangiography(CT cholangiography) are newly developed adjunctives for evaluation of patients with biliary disease(s). We performed MR cholangiography and CT cholangiography through the nasobiliary tube in two patients with PSC, in which typical intrahepatic bile duct changes of PSC were seen as in ERCP. Now, we report MR cholangiographic and CT cholangiographic findings in patients with PSC and suggest that these radiologic studies, especially MR cholangiography, can be used as an alternative methods for serial follow-up after definite diagnosis by ERCP. (Korean J Gastrointest Endosc 17: 716-722, 1997)

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증례 : 담도 췌장 ; 원발성 경화성 담관염에서 발생했다고 추정되는 담관암종 1예 ( Case Reports : Biliary Tract & Pancreas ; A Case of Cholangiocarcinoma Suggested as Developing in the Patient with Primary Sclerosing Cholangitis ): Korean J Gastrointest Endosc 1997;17(1):99-104. Published online November 30, 1996

Abstract PDF: Primary sclerosing cholangitis is a chronic disease of unknown cause, characterized by inflammation and fibrosis of the biliary tree with diffuse multifocal stricture formation. With increasing knowledge of primary sclerosing cholangitis, it is now recognized that in the setting of inflammatory bowel disease, cholangiocarcinoma is a complication of primary sclerosing cholangitis. We recently experienced a case of 41 year old female patient who had Crohns disease associated with primary sclerosing cholangitis and cholangioearcinoma. We report a case of primary sclerosing cholangitis with cholangiocarcinoma with literature review. (Korean J Gastrointest Endosc 17: 99~104, 1997)

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증례 : 식도 위장관 ; 원발성경화성담관염 (原發性硬化性膽管炎) 을 동반한 궤양성대장염 (潰梁性大腸炎) 환자 1예 ( Case Reports : Esophagus , Stomach & Intestine ; A Case of Primary Sclerosing Cholangitis with Ulcerative Colitis ): Korean J Gastrointest Endosc 1996;16(6):1001-1007. Published online November 30, 1995

Abstract PDF: Sclerosing cholangitis is cholestatic disease, characterized by progressive fibrotic inflammation and obliteration af intrahepatic bile ducts and extrahepatic bile ducts and sometimes associated with ulcerative colitis. The pathogenesis of this disease is not understood well. In this disease, however, have been proposed infectious agent, endotoxin of bacteria and immunological event. In Europe and U.S.A., the incidence of sclerosing cholangitis associated with ulcerative colitis was between 2,4 and 4.0 percent. The association is strongest in patients with pancolitis, with a prevalenee of 5.5 percent, compared with patients with disease confined to the distal colon, with a prevalence of 0.5 percent. But, in Korea, it has not been reported sclerosing cholangitis associated with ulcerative colitis. A 30-year old man was diagnosed as an ulcerative colitis 9 years ago and has been followed up, intermittently. Recently, he has experienced hematochezia and dizziness. Colonoscopy showed active ulcerative colitis(pancolitis), blood chemistry elevated alkaline phosphatase and y-GTP. ERCP and liver biopsy specimen revealed sclerosing cholangitis. we concluded that this case was a sclerosing cholangitis as a complication of ulcerative colitis and the first case report of primary sclerosing cholangitis with ulcerative colitis in Korea, Hence, we reported a case of primary sclerosing cholangitis with ulcerative colitis with a review of literatures. (Korean J Gastrointest Endosc 16: 1001-1o07, 1996)

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증례 : 담도 췌장 ; 원발성 경화성 담관염 2예 ( Case Reports : Biliary Tract & Pancreas ; Two Cases of Primary Sclerosing Cholangitis ): Korean J Gastrointest Endosc 1995;15(4):788-795. Published online November 30, 1994

Abstract PDF: Prirnary sclerosing cholangitis, a chronic progressive cholestatic hepatobiliary disorder of unknown etiology, is characterized by inflammation, scarring and obliteration of bile duct leading to biliary cirrhosis and liver failure. Because histologic finding has only a limited role in the diagnosis, the gold standard for establishing the diagnosis is cholangiographic demonstration of typical diffuse biliary stricutre or beading. The natural history is extremely variable. We report two cases of primary sclerosing cholangitis diagnosed by repeated endoscopic retrograde cholangiographies. They were followed up for 7 and 2 years, respectively. (Kor J Gastrointest Endosc 15: 788-794, 1995)

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