Evaluation of a modified cholangiographic classification system for primary sclerosing cholangitis.
BACKGROUND
There is no uniformly accepted classification system for the range of cholangiographic abnormalities encountered in primary sclerosing cholangitis (PSC). The aims of this study were to evaluate a previously developed classification system and to test the hypothesis that the pancreatic duct can be involved in PSC.


METHODS
Two observers scored 132 endoscopic retrograde cholangiopancreatographies (ERCPs) from established PSC patients. From 30 patients, subsequent ERCPs were scored and compared with the initial ERCPs. The pancreatic duct was judged with regard to morphologic abnormalities.


RESULTS
The classification system was applicable in 107 patients. In 10 ERCPs (7.6%), no clear intrahepatic abnormalities were found; 15 other ERCPs (11.4%) did not show extrahepatic abnormalities. In 30 cases, a subsequent ERCP was judged. The difference in scoring between the initial and the subsequent ERCPs was statistically significant, with the subsequent ERCP having higher intrahepatic and extrahepatic scores. Sixty-four adequately filled pancreatic ducts were analyzed. In two cases (3.1%), morphologic abnormalities were found.


CONCLUSIONS
The previously developed scoring system is very applicable for almost all PSC patients when supplemented with a type 0 category. Scoring increased over time, suggesting a correlation with disease severity. The pancreatic duct does not seem to be involved in PSC.
Rajaram
R
R
Department of Radiology, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam Z.O., The Netherlands.
Ponsioen
C Y
CY
Majoie
C B
CB
Reeders
J W
JW
Laméris
J S
JS
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001650:Bile Duct Neoplasms / Q000000981:diagnostic imaging; D001653:Bile Ducts, Intrahepatic; D018281:Cholangiocarcinoma / Q000000981:diagnostic imaging; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000145:classification*; D015209:Cholangitis, Sclerosing / Q000000981:diagnostic imaging*; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010183:Pancreatic Ducts / Q000000981:diagnostic imaging; D018709:Statistics, Nonparametric