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World J Hepatol. Apr 18, 2015; 7(5): 799-805
Published online Apr 18, 2015. doi: 10.4254/wjh.v7.i5.799
Diagnosis and management of primary sclerosing cholangitis-perspectives from a therapeutic endoscopist
Kunjam Modha, Udayakumar Navaneethan
Kunjam Modha, Udayakumar Navaneethan, Digestive Disease Institute, the Cleveland Clinic, Cleveland, OH 44195, United States
Udayakumar Navaneethan, Center for Interventional Endoscopy, Florida Hospital, Orlando, FL 32803, United States
Author contributions: Modha K contributed to study concept and paper preparation; Navaneethan U contributed to study concept, design, paper preparation and critical revisions.
Supported by Research Grants from the Inflammatory Bowel Disease Working Group and the American College of Gastroenterology (to Navaneethan U).
Conflict-of-interest: Navaneethan U has received fees for serving as a speaker, and an advisory board member for AbbVie.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Udayakumar Navaneethan, MD, FACP, Center for Interventional Endoscopy, Florida Hospital, 601 E Rollins Street, Orlando, FL 32803, United States. udhaykumar81@gmail.com
Telephone: +1-216-5020981 Fax: +1-216-4446305
Received: July 14, 2014
Peer-review started: July 14, 2014
First decision: November 14, 2014
Revised: January 6, 2015
Accepted: January 18, 2015
Article in press: January 20, 2015
Published online: April 18, 2015
Processing time: 279 Days and 11.3 Hours
Abstract

Primary sclerosing cholangitis (PSC) is a chronic, cholestatic liver condition characterized by inflammation, fibrosis, and destruction of the intra- and extrahepatic bile ducts. The therapeutic endoscopist plays a key role in the diagnosis and management of PSC. In patients presenting with a cholestatic profile, endoscopic retrograde cholangiopancreatography (ERCP) is warranted for a definite diagnosis of PSC. Dominant strictures of the bile duct occur in 36%-57% of PSC patients. Endoscopic balloon dilatation with or without stenting have been employed in the management of dominant strictures. In addition, PSC patients are at increased risk of developing cholangiocarcinoma with a 20% lifetime risk. Brush cytology obtained during ERCP and use of fluorescence in situ hybridization forms the initial diagnostic step in the investigation of patients with dominant biliary strictures. Our review aims to summarize the current evidence supporting the role of a therapeutic endoscopist in the management of PSC patients.

Keywords: Endoscopy; Therapeutic endoscopy; Primary sclerosing cholangitis; Bile; Dominant strictures

Core tip: A therapeutic endoscopist plays a key role in the diagnosis and management of patients with primary sclerosing cholangitis (PSC). Endoscopic balloon dilation of dominant strictures with or without stenting is performed. Brush cytology obtained during endoscopic retrograde cholangiopancreatography and use of fluorescence in situ hybridization forms the initial diagnostic step in the investigation of patients with dominant biliary strictures. Our review aims to summarize the current evidence supporting the role of a therapeutic endoscopist in the management of PSC patients.