Predictive criteria of response to endoscopic treatment for severe strictures in primary sclerosing cholangitis - 25/07/19
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Highlights |
• | In patients with primary sclerosing cholangitis (PSC), there is a need of objective predictive criteria of improvement after endoscopic treatment, especially in case of severe stricture without acute clinical manifestation (jaundice or acute cholangitis). |
• | Features of magnetic resonance cholangiography, performed before endoscopic treatment, were evaluated according to a standard model of interpretation and a radiologic qualitative score of probability of improvement after endoscopic treatment was built. |
• | Score 3 (improvement likely) was given in case of severe common bile duct stricture with marked dilatation without severe strictures of upstream ducts, score 1 (improvement unlikely) was given in case of severe multiple strictures of secondary ducts without biliary dilatation and score 2 (undeterminate) was given to an intermediate pattern. |
• | Short left hepatic duct stricture, bilirubin, transaminases, pruritus and score 3 (improvement likely) were associated with response to endoscopic treatment. |
• | Magnetic resonance cholangiography, together with biochemical features, may contribute to identify patients with PSC who are likely to be improved after endoscopic treatment for severe strictures of extrahepatic bile ducts. |
• | A validation in a larger cohort is warranted to confirm these results, especially in patients without an evident indication to endoscopic treatment. |
Summary |
Background |
The aim of this study was to identify predictive criteria of improvement after endoscopic treatment (ET) for severe strictures of extrahepatic bile ducts in patients with primary sclerosing cholangitis (PSC).
Methods |
PSC patients who had at least one ET for severe stricture were included. Features of magnetic resonance cholangiography (MRC), performed before ET, were evaluated according to a standard model of interpretation, and a radiologic qualitative score of probability of improvement after ET was built. Score 3 (likely) was given in case of severe common bile duct (CBD) stricture with marked dilatation without severe strictures of upstream ducts, Score 1 (unlikely) was given in case of severe multiple strictures of secondary ducts without biliary dilatation and Score 2 (undeterminate) was given to an intermediate pattern. The response to ET was assessed at 2 months (T2-response) from the last ET and at 12 months (T12-response) from inclusion.
Results |
Thirty-one patients were included. All had severe stricture (reduction ≥ 75% of the diameter) of CBD and 50% had severe stricture of right and/or left hepatic duct (LHD) at MRC before ET. According to the qualitative score, 16 patients had Score 3, 7 had Score 1 and 9 had Score 2. T12-response was obtained in 50% of patients. In univariate analysis, short LHD strictures, bilirubin, transaminases, pruritus and Score 3 were associated with T12-response. Increased bilirubin and transaminases were independent predictive factors of T12-response (HR 24, 95% CI: 3.4–170.4, P = 0.001 and 23.8, 95% CI: 3.4–169.4, P = 0.002, respectively).
Conclusion |
MRC, together with biochemical features, may contribute to identify the PSC patients who are likely to be improved after ET for severe strictures of extrahepatic bile ducts.
Le texte complet de cet article est disponible en PDF.Keywords : Dominant stenosis, Endoscopic retrograde cholangiopancreatography, Magnetic resonance imaging, Sensitivity and specificity
Plan
Vol 43 - N° 4
P. 387-394 - août 2019 Retour au numéro
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