Chemotherapy-induced sclerosing cholangitis: long-term response to endoscopic therapy.
BACKGROUND
Hepatic arterial infusion of fluoropyrimidines has been widely used for the treatment of hepatic metastasis from colorectal cancer. One major complication of such treatment is biliary sclerosis resembling primary sclerosing cholangitis, which has an incidence ranging from 8% to 26%.


OBJECTIVE
We evaluated the efficacy and long-term outcome of endoscopic therapy in the management of chemotherapy-induced sclerosing cholangitis (CISC).


METHODS
With the use of an endoscopic retrograde cholangiopancreatography (ERCP) database, all patients with a diagnosis of CISC who had endoscopic therapy between March 1995 and March 2005 were identified. The indications, findings, therapies, and complications for all patients undergoing ERCP were recorded in this database. Additional information was obtained by review of medical records.


RESULTS
Eleven patients (six men and five women) were identified. The mean age at presentation was 59.5 years (range, 36-76 years). Cholangiogram findings revealed stricture confined to the common hepatic duct in two patients, involving the hilum in seven patients, involving the right and/or left main hepatic ducts in nine patients, and extending to the intrahepatic radicals in two patients. All patients had successful endoscopic therapy to alleviate the presenting symptom. The grade and extent of biliary strictures did not change in five patients, improved in one patient, recurred in two patients, and progressed in two patients over the follow-up period of 28.2 months (range, 4-60 months).


CONCLUSIONS
Although long-term follow-up of patients with CISC is limited by the dismal prognosis of the underlying malignancy, CISC has a recalcitrant pattern that rarely improves with endoscopic therapy. However, endoscopic therapy seems to be an effective method of palliation.
Alazmi
Waleed M
WM
Indiana University Medical Center, 550 N. University Blvd, Indianapolis, 46202, USA.
McHenry
Lee
L
Watkins
James L
JL
Fogel
Evan L
EL
Schmidt
Suzette
S
Sherman
Stuart
S
Lehman
Glen L
GL
D000328:Adult; D000368:Aged; D000469:Alkaline Phosphatase / Q000097:blood; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects*; D002760:Cholangiopancreatography, Endoscopic Retrograde; D015209:Cholangitis, Sclerosing / Q000139:chemically induced* / Q000628:therapy*; D003110:Colonic Neoplasms / Q000473:pathology; D003251:Constriction, Pathologic; D005260:Female; D005467:Floxuridine / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use; D005472:Fluorouracil / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use; D006500:Hepatic Duct, Common / Q000473:pathology; D006801:Humans; D007261:Infusions, Intra-Arterial; D008113:Liver Neoplasms / Q000188:drug therapy / Q000556:secondary; D008297:Male; D008875:Middle Aged; D010166:Palliative Care; D012189:Retrospective Studies; D016896:Treatment Outcome
D005467:Floxuridine; D000469:Alkaline Phosphatase; D005472:Fluorouracil