Obstructive jaundice in autoimmune pancreatitis can be safely treated with corticosteroids alone without biliary stenting.
OBJECTIVE
Autoimmune pancreatitis (AIP) responds dramatically to corticosteroids treatment. We reviewed our experience to determine the safety and effectiveness of treating obstructive jaundice in definitive AIP with corticosteroids alone without biliary stenting.


METHODS
From our AIP database, we retrospectively identified type 1 AIP subjects whose jaundice was treated with corticosteroids alone without biliary stenting. Their medical records were reviewed and clinical data were evaluated to determine the outcomes.


RESULTS
Fifteen AIP subjects (87% male, mean age 68.4 years) were treated with corticosteroids at initial presentation (n = 8), first (n = 5) or subsequent (n = 2) relapse. Mean values (upper limit of normal, ULN) of liver tests prior to corticosteroids were aspartate aminotransferase (AST) 203.5u/l (4 × ULN), alanine aminotransferase (ALT) 325.8u/l (6 × ULN), alkaline phosphatase (ALP) 567.4u/l (5 × ULN), and total bilirubin (TB) 5.9 mg/dl (5.9 × ULN). At first follow-up (mean 4 days) the decrease was 54.9% for AST, 51.6% for ALT, 33% for ALP and 47.2% for TB (all p < 0.05). After 15-45 days, all patients had normal AST, 3/15 had ALT > 1.5 × ULN, 1/15 had ALP > 1.5 × ULN, 1/15 had TB > 1.5 × ULN. No patient required biliary stent placement, or developed cholangitis or other infectious complications during steroid treatment.


CONCLUSIONS
Under the supervision of an experienced pancreatologist and with close monitoring of patients, obstructive jaundice secondary to definitive AIP can be safely and effectively managed with corticosteroids alone, without the need for biliary stenting.
Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA.
Yan
Y
Bi
Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA; Division of Gastroenterology, Hepatology, and Nutrition, The Ohio State University, Columbus, OH, USA.
Phil A
PA
Hart
Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA.
Ryan
R
Law
Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA.
Jonathan E
JE
Clain
Division of Surgery, Mayo Clinic, Rochester, MN, USA.
Michael B
MB
Farnell
Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA.
Ferga C
FC
Gleeson
Division of Surgery, Mayo Clinic, Rochester, MN, USA.
Michael L
ML
Kendrick
Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA.
Mike J
MJ
Levy
Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA.
Randall K
RK
Pearson
Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA.
Bret T
BT
Petersen
Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA.
Lisa D
LD
Pisney
Division of Pathology, Mayo Clinic, Rochester, MN, USA.
Thomas C
TC
Smyrk
Division of Radiology, Mayo Clinic, Rochester, MN, USA.
Naoki
N
Takahashi
Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA.
Mark D
MD
Topazian
Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA.
Santhi Swaroop
SS
Vege
Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA. Electronic address: chari.suresh@mayo.edu.
Suresh T
ST
Chari
D000305:Adrenal Cortex Hormones / Q000627:therapeutic use*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use*; D001327:Autoimmune Diseases / Q000150:complications*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D041781:Jaundice, Obstructive / Q000188:drug therapy* / Q000209:etiology; D008297:Male; D008875:Middle Aged; D050500:Pancreatitis, Chronic / Q000150:complications*; D012189:Retrospective Studies; D015607:Stents; D016896:Treatment Outcome
D000305:Adrenal Cortex Hormones; D000893:Anti-Inflammatory Agents
Autoimmune pancreatitis; Cholangitis; Chronic pancreatitis; ERCP (Endoscopic retrograde cholangiopancreatography); Obstructive jaundice; Prednisone