The Usefulness of Biopsying the Major Duodenal Papilla to Diagnose Autoimmune Pancreatitis: A Prospective Study Using IgG4-Immunostaining

Kamisawa, Terumi; Egawa, Naoto; Nakajima, Hitoshi; Tsuruta, Kouji; Okamoto, Akira

doi:10.1016/j.gie.2006.03.039

Cited by 18 publications

(25 citation statements)

References 11 publications

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“…60,61 igG4 immunostaining of biopsy specimens taken from the major duodenal papilla of patients with aiP is useful to support the diagnosis of aiP. 62,63 although a steroid diagnostic trial is useful in some cases to differentiate aiP from pancreatic cancer, 64 it should only be performed with extreme caution by pancreatolo gists and in limited cases after a negative workup for pancreatic cancer, including eusguided fineneedle aspiration. 59,65,66 treatment and prognosis although aiP improves spontaneously in some patients, 67 orally administered steroids are the standard therapy.…”

Section: Key Pointsmentioning

confidence: 99%

Autoimmune pancreatitis and IgG4-related sclerosing disease

Kamisawa

Takuma

Egawa

et al. 2010

Nat Rev Gastroenterol Hepatol

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192

134

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Autoimmune pancreatitis (AIP) is a unique form of pancreatitis in which the pathogenesis is suspected to involve autoimmune mechanisms. AIP sometimes mimics pancreatic cancer in its presentation, but as AIP responds dramatically to steroid therapy, accurate diagnosis is necessary. AIP is currently diagnosed on the basis of a combination of characteristic clinical, serological, morphological and histopathological features. However, its diagnosis remains a clinical challenge and there are no internationally agreed diagnostic criteria. Another type of AIP called 'idiopathic duct-centric chronic pancreatitis' or 'AIP with granulocytic epithelial lesion' has been reported in Western countries. IgG4-related sclerosing disease is a systemic disease in which IgG4-positive plasma cells and T lymphocytes extensively infiltrate various organs. Organs with tissue fibrosis and obliterative phlebitis, such as the pancreas, salivary gland and retroperitoneum, show clinical manifestations; AIP seems to represent one manifestation of IgG4-related sclerosing disease. As a mass is formed in most cases of IgG4-related sclerosing disease, a malignant tumor is frequently suspected on initial presentation. Clinicians should consider IgG4-related sclerosing disease in the differential diagnosis to avoid unnecessary surgery.

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Section: Key Pointsmentioning

confidence: 99%

Autoimmune pancreatitis and IgG4-related sclerosing disease

Kamisawa

Takuma

Egawa

et al. 2010

Nat Rev Gastroenterol Hepatol

Self Cite

192

134

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“…However, pancreatic biopsy specimens may not be easily obtained in all centers. Two groups in Japan observed this year that biopsies from the major papilla in patients with AIP were more likely to demonstrate infiltration of IgG4-positive plasma cells than controls [33] or patients with alcoholic pancreatitis [34]. In addition, this abundant plasma cell infiltration predicted the response to corticosteroids in these two studies.…”

Section: Autoimmune Pancreatitis (Aip)mentioning

confidence: 88%

ERCP topics

Cheon¹,

Fogel²

2006

Endoscopy

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IntroductionEndoscopic retrograde cholangiopancreatography (ERCP) has evolved significantly during the last two decades. While endoscopic management of biliary obstruction was initially hailed as a breakthrough, ERCP has developed tremendously and now offers a number of therapeutic applications. Although many endoscopists have expanded their armamentarium to include complex and controversial areas such as the management of pancreatitis, fluid collections, and sphincter of Oddi dysfunction (SOD), serious complications continue to occur. Numerous abstracts presented at this year's Digestive Disease Week (DDW) meeting addressed new techniques, while others focused on improving procedure safety. Selected abstracts are reviewed here. Post-ERCP pancreatitis and other complicationsPrevention of postprocedural complications was the focus of several abstracts this year. ERCP-induced pancreatitis continues to be a relevant clinical problem, despite technical advances and better understanding of predisposing factors. Identifying preprocedural risk factors may allow better case selection, excluding the highest-risk patients. The Indiana group examined the relationship between the extent of pancreatic duct filling and frequency of pancreatitis in 14 487 ERCPs [1]. Patients were divided into four groups according to the extent of pancreatic duct opacification: Group 1 (n = 6890) had no attempted opacification of the pancreatic duct; group 2, opacification of the head only; group 3, opacification of the head and body; group 4, opacification to the tail. The post-ERCP pancreatitis rates in each group were 1.0 %, 3.5 %, 4.6 %, and 8.5 %, respectively. There was a significantly higher incidence of pancreatitis with increased opacification of the pancreatic ductal system (P < 0.001), suggesting that less filling of the pancreatic duct was associated with less post-ERCP pancreatitis. It follows, therefore, that preprocedure magnetic resonance pancreatography may allow less pancreatic duct filling at ERCP, improving the safety of the procedure. Cost-benefit analyses, however, will be necessary to determine whether this strategy is a real option.Precut sphincterotomy to gain access to the common bile duct has been associated with a high risk of pancreatitis. In contrast, needle-knife sphincterotomy over a pancreatic stent has been shown to be safer than conventional pull-type sphincterotomy without a stent in patients with SOD. There have been no prospective studies comparing outcomes between the two techniques. A report from Alabama [2] prospectively compared the post-ERCP pancreatitis rate among high-risk patients undergoing two different endoscopic pancreatic sphincterotomy (EPS) techniques. Forty-eight patients diagnosed with pancreatic sphincter hypertension were randomly assigned to undergo EPS using a needle-knife over a pancreatic stent (n = 24) or with a pull-type sphincterotome followed by pancreatic stent (n = 24). The post-ERCP pancreatitis rate was significantly higher among patients undergoing EPS using the pull-type sph...

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“…According to Ghazale et al [34], 82 Systemic disorders with rheumatic manifestations IgG4 levels more than 280 mg/dl are highly suggestive of AIP over pancreatic cancer. IgG4 immunostaining of biopsy specimens taken from the major duodenal papilla supports a diagnosis of AIP [35,36]. Although steroid trials are useful in differentiating AIP from pancreatic cancer, this should be performed only after a negative work-up of pancreatic cancer including EUS-FNA, to avoid misdiagnosing pancreatic cancer as AIP [4].…”

Section: Differential Diagnosis From Pancreatic Cancermentioning

confidence: 99%