[Primary sclerosing cholangitis: contribution of retrograde cholangiography in follow-up: apropos of 15 case reports].
From 1975 to 1989, primary sclerosing cholangitis (PSC) was diagnosed in 15 patients especially based on cholangiographic features associated with clinical, biological and histological findings. 93 p. cent of patients had altered liver enzymes at the diagnosis time but only 26% was asymptomatic. 33 p. cent had a concomittant inflammatory bowel disease. Retrograde cholangiography showed injuries of the intrahepatic ducts in 93 p. cent; the more frequently observed lesions were short and multifocal strictures, associated with irregularities of the biliary wall or decreased arborization of intrahepatic bile ducts, but without marked dilatation. Mean follow-up was 44 months (3 to 120). Actuarial survival was 48 p. cent at 5 years. In 4 patients, because of poor clinical and biological (serum bilirubin greater than or equal to 4 mg/dl) evolution, a second retrograde cholangiography was performed showing in all cases apparition of marked ductal dilatation in extra-hepatic (one case) or in intra-hepatic bile ducts (three cases). We diagnosed one benign extra-hepatic stricture, two cholangiocarcinoma and one biliary cirrhosis complicating PSC. We concluded that retrograde cholangiography is necessary if jaundice appears to diagnose every complications of PSC. Apparition of marked ductal dilatation should be the witness of pejorative evolution, especially apparition of cholangiocarcinoma that must be excluded.
Van Laethem
J L
JL
Département d'Hépato-Gastro-Entérologie Médico-Chirurgicale, Hôpital Erasme, Université Libre de Bruxelles.
Adler
M
M
Bougeois
N
N
Deprez
C
C
Ryckaert
F
F
Zalcman
M
M
Gelin
M
M
Cremer
M
M
D000328:Adult; D000368:Aged; D001652:Bile Ducts / Q000473:pathology; D002760:Cholangiopancreatography, Endoscopic Retrograde; D015209:Cholangitis, Sclerosing / Q000150:complications / Q000000981:diagnostic imaging* / Q000473:pathology; D003251:Constriction, Pathologic; D005260:Female; D006801:Humans; D015212:Inflammatory Bowel Diseases / Q000150:complications; D008099:Liver / Q000201:enzymology; D008297:Male; D008875:Middle Aged
Cholangite sclérosante primitive: contribution de la cholangiographie rétrograde dans le follow-up: à propos de 15 observations.