Endoscopic retrograde Cholangiographic evaluation of sclerosing cholangitis

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Sclerosing cholangitis is a chronic inflammatory fibrosing process involving the septal and larger intrahepatic ducts. It has been described as occurring separately or in association with inflammatory bowel disease, retroperitoneal fibrosis, or Riedel’s thyroiditis. Clinically, the patient may be asymptomatic or jaundiced. Microscopically, sclerosing cholangitis is identified by a nonspecific inflammatory infiltrate surrounding the ductal system with evidence of ductal fibrosis. The absence of ductal proliferation is a key feature in distinguishing it from primary biliary cirrhosis. The natural course of the disease is variable, and many patients eventually die of hepatic failure or portal hypertension. However, a number of reports indicate that the condition of patients with primary sclerosing cholangitis may stabilize for several years.

There is presently no definitive means of monitoring patients with sclerosing cholangitis. Although liver biopsy is the most accurate means of assessing the intrahepatic inflammatory process, biopsy supplies only indirect evidence of the status of extrahepatic sclerosis. In past reports1, 2 investigators have indicated a need for a second laparotomy in these patients, but others have suggested the use of percutaneous trans-heptic cholangiography3 in assessing the status of the extrahepatic ductal system prior to surgery. A less invasive technique would obviously be beneficial in following patients with primary sclerosing cholangitis.

This report outlines the progress of a patient with sclerosing cholangitis. The status of the extrahepatic ducts was reevaluated by endoscopic retrograde cholangiography. The value of this technique in assessing patients with primary sclerosing cholangitis is discussed.

Case report

A 37-year-old white man was. . .



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