title: Comparison of intraductal ultrasonography findings between primary sclerosing cholangitis and IgG4-related sclerosing cholangitis.
abstract: OBJECTIVE
  Comparisons of intraductal ultrasonography (IDUS) findings between primary sclerosing cholangitis (PSC) and IgG4-related sclerosing cholangitis (IgG4-SC) have not been elucidated. We aimed to clarify the differences in transpapillary IDUS findings between PSC and IgG4-SC.
  
  
  METHODS
  We retrospectively compared transpapillary IDUS findings between 15 patients with PSC and 35 patients with IgG4-SC between 2004 and 2014.
  
  
  RESULTS
  IDUS findings of circular-asymmetric wall thickness, irregular inner margin, diverticulum-like outpouching, unclear outer margin, heterogeneous internal echo, and disappearance of three layers were significantly higher in PSC than in IgG4-SC (P < 0.001). Irregular inner margin, diverticulum-like outpouching, and disappearance of three layers were specific IDUS findings for PSC compared to IgG4-SC. Diverticulum-like outpouching on IDUS and endoscopic retrograde cholangiogram (ERC) was observed in 10 (67%) and five (33%) of 15 patients with PSC, respectively. However, based on IDUS and ERC, diverticulum-like outpouching was not observed in any patient with IgG4-SC. All five patients with diverticulum-like outpouching on ERC had diverticulum-like outpouching on IDUS, and five (50%) of 10 patients without diverticulum-like outpouching on ERC had diverticulum-like outpouching on IDUS.
  
  
  CONCLUSIONS
  The IDUS findings differed between PSC and IgG4-SC. Irregular inner margin, diverticulum-like outpouching, and disappearance of three layers are specific IDUS findings for PSC compared to IgG4-SC. IDUS is a more useful procedure than ERC for the early detection of diverticulum-like outpouching.
authors.affiliation: Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan.
authors.forename: Itaru
authors.initials: I
authors.lastname: Naitoh
authors.forename: Takahiro
authors.initials: T
authors.lastname: Nakazawa
authors.forename: Kazuki
authors.initials: K
authors.lastname: Hayashi
authors.forename: Katsuyuki
authors.initials: K
authors.lastname: Miyabe
authors.forename: Shuya
authors.initials: S
authors.lastname: Shimizu
authors.forename: Hiromu
authors.initials: H
authors.lastname: Kondo
authors.forename: Yuji
authors.initials: Y
authors.lastname: Nishi
authors.forename: Michihiro
authors.initials: M
authors.lastname: Yoshida
authors.forename: Shuichiro
authors.initials: S
authors.lastname: Umemura
authors.forename: Yasuki
authors.initials: Y
authors.lastname: Hori
authors.forename: Akihisa
authors.initials: A
authors.lastname: Kato
authors.forename: Fumihiro
authors.initials: F
authors.lastname: Okumura
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Sano
authors.forename: Hirotaka
authors.initials: H
authors.lastname: Ohara
authors.forename: Takashi
authors.initials: T
authors.lastname: Joh
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001652:Bile Ducts / Q000000981:diagnostic imaging*; D001660:Biliary Tract Diseases; D002760:Cholangiopancreatography, Endoscopic Retrograde; D015209:Cholangitis, Sclerosing / Q000145:classification / Q000000981:diagnostic imaging* / Q000209:etiology; D003937:Diagnosis, Differential; D004240:Diverticulum; D005260:Female; D006801:Humans; D007074:Immunoglobulin G; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D018084:Ultrasonography, Interventional / Q000379:methods*; D055815:Young Adult
chemical_list: D007074:Immunoglobulin G
keywords: IgG4-related sclerosing cholangitis; cholangiogram; diverticulum-like outpouching; intraductal ultrasonography; primary sclerosing cholangitis