Differentiating sclerosing cholangitis caused by autoimmune pancreatitis and primary sclerosing cholangitis according to endoscopic duodenal papillary features.
BACKGROUND
Differentiating primary sclerosing cholangitis (PSC) and sclerosing cholangitis caused by autoimmune pancreatitis (SC-AIP) is often challenging. Recently, endoscopic findings of the duodenal papilla in cases with AIP or PSC were reported by Unno and Parlak, although the endoscopic differentiation of these 2 conditions has not yet been fully clarified.


OBJECTIVE
Our purpose was to clarify the endoscopic findings of the duodenal papilla in patients with SC-AIP and those with PSC and to determine criteria for the differentiation of these conditions.


METHODS
Case series.


METHODS
Retrospective.


METHODS
Twenty-seven patients with SC-AIP and 12 patients with PSC who had undergone ERCP were identified from our database. We reviewed these records to determine whether the duodenal papillary findings (swollen papilla/normal papilla/small papilla) might be potentially useful for differentiating SC-AIP and PSC. Immunohistopathological findings for the duodenal papilla were also examined by using immunoglobulin G4 (IgG4) among the infiltrating plasma cells.


METHODS
ERCP, biopsy specimen taken from duodenal papilla.


METHODS
The presence of a swollen duodenal papilla with IgG4-positive plasma cells was useful for discriminating SC-AIP from with PSC.


RESULTS
A swollen duodenal papilla was observed in 63% (17/27) of the patients with SC-AIP, whereas there was no swelling of the duodenal papilla of the patients with PSC. A small papilla was recognized in 50% (6/12) of the patients with PSC. IgG4-positive plasma cells in the duodenal papilla were significantly detected in the patients with SC-AIP but not in the patients with PSC.


CONCLUSIONS
Single-center study.


CONCLUSIONS
Characteristic duodenal endoscopic papillary features in patients with SC-AIP, such as a swollen duodenal papilla and positive immunostaining for IgG4, might be helpful for discriminating this condition from PSC.
Kubota
Kensuke
K
Division of Gastroenterology, Yokohama Rosai Hospital, Yokohama City University, Graduate School of Medicine, Kanazawa, Yokohama, Japan.
Kato
Shingo
S
Akiyama
Tomoyuki
T
Yoneda
Masato
M
Fujita
Koji
K
Ogawa
Masami
M
Inamori
Masahiko
M
Kobayashi
Noritoshi
N
Saito
Satoru
S
Kakuta
Yukio
Y
Ohshiro
Hisashi
H
Nakajima
Atsushi
A
D000328:Adult; D000368:Aged; D014670:Ampulla of Vater / Q000473:pathology*; D001327:Autoimmune Diseases / Q000150:complications*; D015209:Cholangitis, Sclerosing / Q000175:diagnosis* / Q000209:etiology*; D003937:Diagnosis, Differential; D004384:Duodenoscopy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010195:Pancreatitis / Q000150:complications*; D012189:Retrospective Studies