Cholangiography can discriminate sclerosing cholangitis with autoimmune pancreatitis from primary sclerosing cholangitis.
BACKGROUND
Sclerosing cholangitis with autoimmune pancreatitis has a cholangiographic appearance that is similar to that of primary sclerosing cholangitis, but only the former responds well to corticosteroid therapy. It, therefore, is necessary to distinguish between these two diseases. Cholangiography is the reference standard for the diagnosis of primary sclerosing cholangitis. The present study compared the characteristic findings for these two types of sclerosing cholangitis.


METHODS
Cholangiograms from patients with primary sclerosing cholangitis (n = 29) and sclerosing cholangitis with autoimmune pancreatitis (n = 26) were studied with regard to length and region of stricture formation, and other characteristic findings.


RESULTS
Band-like stricture, beaded or pruned-tree appearance, and diverticulum-like formation were significantly more frequent in primary sclerosing cholangitis. In contrast, segmental stricture, long stricture with prestenotic dilatation and stricture of the distal common bile duct were significantly more common in sclerosing cholangitis with autoimmune pancreatitis. Discriminant analysis based on these findings correctly identified 27 of 28 patients with primary sclerosing cholangitis and 25 of 26 patients with sclerosing cholangitis with autoimmune pancreatitis. It also identified a patient with an incorrect diagnosis of primary sclerosing cholangitis who proved, on review of a surgical specimen, to have findings consistent with lymphoplasmacytic sclerosing cholangitis.


CONCLUSIONS
Characteristic cholangiographic features allow discrimination of sclerosing cholangitis with autoimmune pancreatitis and lymphoplasmacytic sclerosing cholangitis without pancreatitis from primary sclerosing cholangitis.
Nakazawa
Takahiro
T
Department of Internal Medicine and Bioregulation, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya 467-8601, Japan.
Ohara
Hirotaka
H
Sano
Hitoshi
H
Aoki
Shigeru
S
Kobayashi
Shinya
S
Okamoto
Tetsu
T
Imai
Hideto
H
Nomura
Tomoyuki
T
Joh
Takashi
T
Itoh
Makoto
M
D000328:Adult; D000368:Aged; D001327:Autoimmune Diseases / Q000000981:diagnostic imaging* / Q000473:pathology; D017734:Bile Ducts, Extrahepatic / Q000473:pathology; D002760:Cholangiopancreatography, Endoscopic Retrograde; D015209:Cholangitis, Sclerosing / Q000000981:diagnostic imaging* / Q000473:pathology; D015529:Choledochal Cyst / Q000000981:diagnostic imaging / Q000473:pathology; D001651:Cholestasis, Extrahepatic / Q000000981:diagnostic imaging / Q000473:pathology; D003135:Common Bile Duct / Q000473:pathology; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D008214:Lymphocytes / Q000473:pathology; D008297:Male; D008875:Middle Aged; D010195:Pancreatitis / Q000000981:diagnostic imaging* / Q000473:pathology; D010950:Plasma Cells / Q000473:pathology; D012680:Sensitivity and Specificity