title: The role of peroral video cholangioscopy in patients with IgG4-related sclerosing cholangitis.
abstract: BACKGROUND
  The cholangioscopic features of IgG4-related sclerosing cholangitis (IgG4-SC) remain undefined. The aim of this study was to clarify these endoscopic features using peroral video cholangioscopy (PVCS) in IgG4-SC patients.
  
  
  METHODS
  PVCS was performed in 33 patients: IgG4-SC (n = 13); primary sclerosing cholangitis (PSC; n = 5); and cholangiocarcinoma (n = 15), which included hilar cholangiocarcinoma (HCCA; n = 5) and distal cholangiocarcinoma (DCCA; n = 10).
  
  
  RESULTS
  The most frequent findings on PVCS in the IgG4-SC patients were dilated (62 %) and tortuous (69 %) vessels, and absence of partially enlarged vessels. The incidence of dilated and tortuous vessels was significantly higher in IgG4-SC patients than in PSC patients (p = 0.015). Scarring and pseudodiverticula were found significantly more often in PSC patients than in IgG4-SC patients (p = 0.001 and p = 0.0007, respectively). The incidence of partially enlarged vessels was significantly higher in DCCA patients than in IgG4-SC patients (p = 0.004). In contrast, the incidence of dilated vessels was significantly higher in IgG4-SC patients than in HCCA patients (p = 0.015). PVCS performed after corticosteroid therapy showed resolution of bile duct stenosis and dilated, tortuous, or partially enlarged vessels, as well as resolution of friability in all patients with IgG4-SC.
  
  
  CONCLUSIONS
  Cholangioscopy was useful in differentiating IgG4-SC from PSC. In addition, monitoring the patterns of proliferative vessels on PVCS may be useful to differentiate IgG4-SC from cholangiocarcinoma.
authors.affiliation: Department of Gastroenterology and Hepatology, Tokyo Medical University Hospital, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan. itoi@tokyo-med.ac.jp
authors.forename: Takao
authors.initials: T
authors.lastname: Itoi
authors.forename: Terumi
authors.initials: T
authors.lastname: Kamisawa
authors.forename: Yoshinori
authors.initials: Y
authors.lastname: Igarashi
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Kawakami
authors.forename: Ichiro
authors.initials: I
authors.lastname: Yasuda
authors.forename: Fumihide
authors.initials: F
authors.lastname: Itokawa
authors.forename: Yuui
authors.initials: Y
authors.lastname: Kishimoto
authors.forename: Masaki
authors.initials: M
authors.lastname: Kuwatani
authors.forename: Shinpei
authors.initials: S
authors.lastname: Doi
authors.forename: Seiichi
authors.initials: S
authors.lastname: Hara
authors.forename: Fuminori
authors.initials: F
authors.lastname: Moriyasu
authors.forename: Todd H
authors.initials: TH
authors.lastname: Baron
mesh_terms: D000368:Aged; D001327:Autoimmune Diseases / Q000175:diagnosis* / Q000188:drug therapy; D001650:Bile Duct Neoplasms / Q000175:diagnosis; D001653:Bile Ducts, Intrahepatic; D001659:Biliary Tract / Q000098:blood supply; D001808:Blood Vessels / Q000473:pathology; D018281:Cholangiocarcinoma / Q000175:diagnosis; D015209:Cholangitis, Sclerosing / Q000175:diagnosis* / Q000188:drug therapy; D003937:Diagnosis, Differential; D004108:Dilatation, Pathologic / Q000175:diagnosis; D016145:Endoscopy, Digestive System / Q000379:methods*; D005260:Female; D005938:Glucocorticoids / Q000627:therapeutic use; D006801:Humans; D007074:Immunoglobulin G / Q000032:analysis*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D014741:Video Recording
chemical_list: D005938:Glucocorticoids; D007074:Immunoglobulin G