Nonoperative dilatation of dominant strictures in primary sclerosing cholangitis

May, G; Ce, Bender; LaRusso, N. F.; Wiesner, R H

doi:10.2214/ajr.145.5.1061

Cited by 86 publications

(48 citation statements)

References 8 publications

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“…ERC with biliary balloon dilatation and/or stenting as well as biliary cytology brushing is frequently employed in the evaluation and management of DSs and may yield clinical benefit and valuable diagnostic information 9, 19, 20, 21, 22, 23, 24, 25, 26. Indeed, a study by Baluyut et al18 of 63 asymptomatic and symptomatic patients with PSC and a DS who underwent endoscopic therapy with balloon dilatation revealed improved 5‐year survival as estimated by the Mayo Risk Score; this study and others18, 27 suggest that endoscopic intervention for DSs may confer a sustained benefit and potentially alter the natural history of PSC.…”

Section: Discussionmentioning

confidence: 99%

“…Median transplant‐free survival from time of PSC diagnosis is variable, ranging from approximately 12‐21 years in most studies, with more recent estimates being toward the top end of this range 4, 5, 6, 7, 8. It has been reported that 40%‐58% of patients with PSC will develop focal high‐grade strictures, referred to as a “dominant stricture” (DS), during the course of disease 5, 9, 10, 11, 12. Patients with a DS may remain asymptomatic or may present with worsening serum liver tests, abdominal pain, and/or cholangitis 9.…”

mentioning

confidence: 99%

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Dominant strictures in primary sclerosing cholangitis: A multicenter survey of clinical definitions and practices

Hilscher

Tabibian

Carey

et al. 2018

Hepatology Communications

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Dominant strictures (DSs) of the biliary tree occur in approximately 50% of patients with primary sclerosing cholangitis (PSC) and may cause significant morbidity. Nevertheless, the definition and management of DSs lacks consensus. We aimed to better understand current perceptions and practices regarding PSC‐associated DSs. We conducted an anonymous, 23‐question, survey‐based study wherein electronic surveys were distributed to 131 faculty in the Division of Gastroenterology and Hepatology at the three Mayo Clinic campuses (Rochester, Scottsdale, and Jacksonville) as well as the affiliated practice network. Responses were aggregated and compared, where applicable, to practice guidelines of the American Association for the Study of Liver Diseases and European Association for the Study of the Liver. A total of 54 faculty (41.2%) completed the survey, of whom 24 (44.4%) were hepatologists, 21 (38.9%) gastroenterologists, and 9 (16.7%) advanced endoscopists. One of the major study findings was that there was heterogeneity among participants' definition, evaluation, management, and follow‐up of DSs in PSC. The majority of participant responses were in accordance with societal practice guidelines, although considerable variation was noted. Conclusion: Despite the prevalence and morbidity of DSs in PSC, clinical perceptions and practices vary widely among hepatologists, gastroenterologists, and advanced endoscopists who manage these patients, even within a single health care system. Further studies are needed to address these variations, develop general and evidence‐based consensus, and increase adherence to societal guidelines. (Hepatology Communications 2018;2:836‐844)

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Dominant strictures in primary sclerosing cholangitis: A multicenter survey of clinical definitions and practices

Hilscher

Tabibian

Carey

et al. 2018

Hepatology Communications

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“…Such lesions may be amenable to nonoperative endoscopic or radiologic dilatation with or without a biliary drainage procedure such as sphincterotomy and stenting, which lead to improvement of clinical symptoms, liver biochemistries, and cholangiographic findings. 24,25 The choice of endoscopic or percutaneous approaches for biliary decompression should be dictated by the site and complexity of the stricture(s), and the availability of local expertise. However, neither endoscopic nor percutaneous dilatation with or without stenting have been shown to have a clear impact on survival, and many of these patients will eventually undergo liver transplantation.…”

Section: Management Of Stenosismentioning

confidence: 99%

Primary sclerosing cholangitis

1999

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“…DOMINANT BILIARY STRICTURES. Dominant strictures of the extrahepatic bile duct occur in 7-20% of patients with PSC (18,43). Several studies reported successful management with endoscopic balloon dilation or biliary stenting of the dominant strictures (44 -47).…”

Section: Management Of Chronic Cholestasis and Its Complicationsmentioning

confidence: 99%

Management of primary sclerosing cholangitis

Lee¹

2002

The American Journal of Gastroenterology

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PREAMBLEGuidelines for clinical practice are intended to indicate preferred approaches to medical problems as established by scientifically valid research. Double blind, placebo-controlled studies are preferable, but reports and expert review articles are also utilized in a thorough review of the literature conducted through the National Library of Medicine's MEDLINE. When only data that will not withstand objective scrutiny are available, a recommendation is identified as a consensus of experts. Guidelines are applicable to all physicians who address the subject, without regard to specialty training or interests, and are intended to indicate the preferable but not necessarily the only acceptable approach to a specific problem. Guidelines are intended to be flexible and must be distinguished from standards of care that are inflexible and rarely violated. Given the wide range of specifics in any health care problem, the physician must always choose the course best suited to the individual patient and the variables in existence at the moment of decision.Guidelines are developed under the auspices of the American College of Gastroenterology and its Practice Parameters Committee and approved by the Board of Trustees. Each has been intensely reviewed and revised by the Committee, other experts in the field, physicians who will use them, and specialists in the science of decision of analysis. The recommendations of each guideline are therefore considered valid at the time of their production based on the data available. New developments in medical research and practice pertinent to each guideline will be reviewed at an established time and indicated at publication to assure continued validity. (Am J Gastroenterol 2002;97:528 -534.

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Nonoperative dilatation of dominant strictures in primary sclerosing cholangitis

Cited by 86 publications

References 8 publications

Dominant strictures in primary sclerosing cholangitis: A multicenter survey of clinical definitions and practices

Dominant strictures in primary sclerosing cholangitis: A multicenter survey of clinical definitions and practices

Primary sclerosing cholangitis

Management of primary sclerosing cholangitis

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