Diagnostic criteria for IgG4-related sclerosing cholangitis based on cholangiographic classification

Nakazawa, Takahiro; Naitoh, Itaru; Hayashi, Kazuki; Okumura, Fumihiro; Miyabe, Katsuyuki; Yoshida, Michihiro; Yamashita, Hiroaki; Ohara, Hirotaka; Joh, Takashi

doi:10.1007/s00535-011-0465-z

Cited by 126 publications

(120 citation statements)

References 20 publications

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“…Nakazawa et al considered biliary stricture limited to the intra-pancreatic area as IgG4-SC. 7,8 Naitoh et al reported that lower bile duct strictures appeared as marked wall thickening in 93% of patients, and as extrinsic compression in 7% of patients, revealing lower bile duct stricture caused mostly by bile duct wall thickening. 12 Other 14 studies also support that lower bile duct stricture in AIP is due to inflammatory processes in the bile duct.…”

Section: Discussionmentioning

confidence: 99%

“…6 Sclerosing cholangitis is a major member of the disease group and is now recognized as IgG4-related sclerosing cholangitis (IgG4-SC) due to the infiltration of IgG4-positive plasma cells observed histologically within and around bile ducts, as well as in the pancreas. 7 IgG4-SC has been classified based on cholangiographic findings of duct stricture. 7,8 According to Nakazawa's classification, stricture in the lower part of the common bile duct is only classified as type 1, stricture diffusely distributed in the intrahepatic and extrahepatic bile duct as type 2, stricture distributed in both the hilar hepatic region and lower part of the common bile duct as type 3, and stricture in only the hilar hepatic region of the bile duct as type 4.…”

Section: Introductionmentioning

confidence: 99%

“…7 IgG4-SC has been classified based on cholangiographic findings of duct stricture. 7,8 According to Nakazawa's classification, stricture in the lower part of the common bile duct is only classified as type 1, stricture diffusely distributed in the intrahepatic and extrahepatic bile duct as type 2, stricture distributed in both the hilar hepatic region and lower part of the common bile duct as type 3, and stricture in only the hilar hepatic region of the bile duct as type 4. According to this classification, lower bile duct stricture mimics the stricture caused by pancreatic cancer, whereas intrahepatic or hilar bile duct stricture mimic those caused by primary 6 sclerosing cholangitis (PSC) or cholangiocarcinoma.…”

Section: Introductionmentioning

confidence: 99%

“…According to this classification, lower bile duct stricture mimics the stricture caused by pancreatic cancer, whereas intrahepatic or hilar bile duct stricture mimic those caused by primary 6 sclerosing cholangitis (PSC) or cholangiocarcinoma. 7,9 Intrahepatic or hilar bile duct strictures are generally accepted to correspond to genuine IgG4-SC and are considered to be typical lesions of IgG4-SC in international consensus diagnostic criteria (ICDC) for autoimmune pancreatitis. 10 However, controversy exists whether lower or intra-pancreatic bile duct stricture, which is frequently complicated with AIP, should be included in IgG4-SC.…”

Section: Introductionmentioning

confidence: 99%

“…[13][14][15] In these cases, an IgG4-related inflammatory process in the bile duct wall may exacerbate lower bile duct stricture, and a comprehensive therapeutic strategy is needed for effective management. 7 Therefore, clarifying the pathogenesis of lower bile duct stricture in AIP or determining whether this lesion is caused by pancreatic head swelling or IgG4-related bile duct inflammation is important. The present study aimed to resolve this issue by analyzing cholangiography, IDUS, and computed tomography (CT), and bile duct histology findings.…”

Section: Introductionmentioning

confidence: 99%

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Mechanisms of Lower Bile Duct Stricture in Autoimmune Pancreatitis

Watanabe

Maruyama²,

Ito³

et al. 2014

Pancreas

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ObjectivesWe attempted to clarify the mechanism underlying lower bile duct stricture in autoimmune pancreatitis. MethodsImaging and histology of the bile duct were assessed for 73 patients with autoimmune pancreatitis to clarify whether IgG4-related biliary inflammation or pancreatic head swelling is associated with lower bile duct stricture. ResultsLower bile duct stricture was found in 59 patients (81%). Pancreatic head swelling was significantly more frequent among patients with lower bile duct stricture than those without (53 (90%) versus 4 (29%); p<0.01). Intraductal ultrasonography revealed lower bile duct wall thickening in 21 of 22 patients with lower bile duct stricture (95%), and lower bile duct wall of patients with pancreatic head swelling was significantly thicker than those without (p=0.028). Among 38 patients with lower bile duct biopsies, 14 (37%) exhibited abundant IgG4-bearing plasma cell infiltration. Among lower bile duct 4 stricture patients, an IgG4-related inflammation seemed to exert a dominant effect under limited conditions, including concomitant middle bile duct stricture and neither pancreatic swelling nor pancreatic duct stricture in the head region. ConclusionsBoth pancreatic head swelling and IgG4-related biliary inflammation influence the occurrence of lower bile duct stricture, which may be included in IgG4-related sclerosing cholangitis. Pancreatic head swelling affects IgG4-related biliary wall thickening.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Mechanisms of Lower Bile Duct Stricture in Autoimmune Pancreatitis

Watanabe

Maruyama²,

Ito³

et al. 2014

Pancreas

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Clinical practice guidelines for IgG4‐related sclerosing cholangitis

Kamisawa

Nakazawa

Tazuma

et al. 2019

J Hepato Biliary Pancreat

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127

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IgG4‐related sclerosing cholangitis (IgG4‐ SC ) is a distinct type of cholangitis frequently associated with autoimmune pancreatitis and currently recognized as a biliary manifestation of IgG4‐related disease. Although clinical diagnostic criteria of IgG4‐ SC were established in 2012, differential diagnosis from primary sclerosing cholangitis and cholangiocarcinoma is sometimes difficult. Furthermore, no practical guidelines for IgG4‐ SC are available. Because the evidence level of most articles retrieved through searching the PubMed, Cochrane Library, and Igaku Chuo Zasshi databases was below C based on the systematic review evaluation system of clinical practice guidelines MINDS 2014, we developed consensus guidelines using the modified Delphi approach. Three committees (a guideline creating committee, an expert panelist committee for rating statements according to the modified Delphi method, and an evaluating committee) were organized. Eighteen clinical questions ( CQ s) with clinical statements were developed regarding diagnosis (14 CQ s) and treatment (4 CQ s). Recommendation levels for clinical statements were set using the modified Delphi approach. The guidelines explain methods for accurate diagnosis, and safe and appropriate treatment of IgG4‐ SC .

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Clinical diagnostic criteria for IgG4‐related sclerosing cholangitis 2020

Nakazawa

Kamisawa

Okazaki

et al. 2021

J Hepato Biliary Pancreat

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Several years have passed since the clinical diagnostic criteria for IgG4‐related sclerosing cholangitis 2012 were published. New findings and knowledge have accumulated since then. The Research Committees for IgG4‐related Diseases and for Intractable Diseases of the Liver and Biliary Tract, in association with the Ministry of Health, Labor, and Welfare of Japan and the Japan Biliary Association, have established a working group consisting of researchers specializing in IgG4‐SC and have drawn up new clinical diagnostic criteria for IgG4‐SC 2020. The diagnosis of IgG4‐SC is based on a combination of the following six criteria: (a) narrowing of the intra‐ or extrahepatic bile duct; (b) thickening of the bile duct wall; (c) serological findings; (d) pathological findings; (e) other organ involvement; and (f) effectiveness of steroid therapy. These new diagnostic criteria for IgG4‐SC are useful in practice for general physicians and other non‐specialists.

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Diagnostic criteria for IgG4-related sclerosing cholangitis based on cholangiographic classification

Abstract: Diagnostic criteria for IgG4-SC based on cholangiographic classification are useful for distinguishing it from PCa, PSC, and CC.

Cited by 126 publications

References 20 publications

Mechanisms of Lower Bile Duct Stricture in Autoimmune Pancreatitis

Mechanisms of Lower Bile Duct Stricture in Autoimmune Pancreatitis

Clinical practice guidelines for IgG4‐related sclerosing cholangitis

Clinical diagnostic criteria for IgG4‐related sclerosing cholangitis 2020

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