Usefulness of endoscopic observation of the main duodenal papilla in the diagnosis of sclerosing pancreatitis

Unno, Hiroshi; Saegusa, Hisanobu; Fukushima, Mana; Hamano, Hideaki

doi:10.1067/mge.2002.129605

Cited by 14 publications

(20 citation statements)

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“…Comment: Supplemental endoscopic biopsy histopathology using IgG4‐immunostaining could contribute to the diagnosis of IgG4‐SC in cases in which the ampulla of Vater is swollen (Fig. a) and there is positive histopathologic evidence of infiltration (i.e.…”

Section: Resultsmentioning

confidence: 99%

“…One case report described isolated‐type IgG4‐related disease of the ampulla of Vater . Although there are no consensus diagnostic criteria available regarding the ampulla of Vater in IgG4‐related disease, it could be considered in diagnosis if there are typical endoscopic findings such as swollen ampulla of Vater associated with hooding‐fold bulging and biopsy histopathologic results indicating infiltration with abundant IgG4‐positive plasma cells . Endoscopic findings such as a swollen ampulla of Vater and endoscopic biopsy results showing abundant IgG4‐positive plasma cell infiltration were noted in 40–80% of patients with IgG4‐SC associated with AIP .…”

Section: Resultsmentioning

confidence: 99%

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Clinical practice guidelines for IgG4‐related sclerosing cholangitis

Kamisawa

Nakazawa

Tazuma

et al. 2019

J Hepato Biliary Pancreat

128

143

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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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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Clinical practice guidelines for IgG4‐related sclerosing cholangitis

Kamisawa

Nakazawa

Tazuma

et al. 2019

J Hepato Biliary Pancreat

128

143

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“…One of these patients had antinuclear antibodies, whereas the other had retroperitoneal fibrosis. Swelling of Vater's ampulla was assessed using an endoscope in all patients according to previously reported criterion 18 . The distribution of pancreatic swelling was also examined by CT.…”

Section: Methodsmentioning

confidence: 99%

IgG4‐related sclerosing cholangitis and autoimmune pancreatitis: Histological assessment of biopsies from Vater's ampulla and the bile duct

Kawakami

Zen

Eto

et al. 2010

J of Gastro and Hepatol

113

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“…An ampullary biopsy would be an easier means of obtaining supplemental diagnostic material than a bile duct biopsy. 14,15,29 A steroid trial is only feasible and effective in cases where a negative work-up for cancer has been obtained. 4 Based on our results, patients with an indeterminant hilar biliary stricture mimicking a Klatskin tumor and an elevated serum IgG4 level, but not an elevated CA19-9 level, might be reasonable candidates for a steroid trial.…”

Section: Discussionmentioning

confidence: 99%

Clinical features of isolated proximal‐type immunoglobulin G4‐related sclerosing cholangitis

Takagi

Kubota

Takayanagi

et al. 2019

Digestive Endoscopy

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Background and Aim Immunoglobulin G4‐related sclerosing cholangitis (IgG4‐SC) presents as isolated proximal‐type sclerosing cholangitis (i‐SC). The present study sought to clarify the imaging differences between i‐SC and Klatskin tumor. Differences between i‐SC and IgG4‐SC associated with autoimmune pancreatitis (AIP‐SC) were also studied. Methods Differentiating factors between i‐SC and Klatskin tumor were studied. Serum IgG4 level, CA19‐9 level, computed tomography (CT) findings, cholangiography findings (symmetrical smooth long stricture extending into the upper bile duct [SSLS]), endosonographic features (continuous symmetrical mucosal lesion to the hilar part [CSML]), endoscopic biopsy results, treatment, relapse, and survival were also compared between patients with i‐SC and those with AIP‐SC. Results For a differential diagnosis between i‐SC (N = 9) and Klatskin tumor (N = 47), the cut‐off value of serum IgG4 level was 150 mg/dL (sensitivity, 0.857, specificity, 0.966). Logistic regression analysis indicated that serum IgG4 level, presence of SSLS, presence of CSML, and presence of swollen ampulla are independent factor for identifying i‐SC. Relapse rate was significantly higher in the IgG4‐SC with AIP group than in the i‐SC group (log rank, P = 0.046). Conclusion Isolated proximal‐type sclerosing cholangitis presents as a nodular lesion with SSLS and/or CSML mimicking a Klatskin tumor. Those endoscopic features might provide a diagnostic clue for i‐SC. i‐SC is likely to have a more favorable prognosis than IgG4‐SC with AIP.

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Usefulness of endoscopic observation of the main duodenal papilla in the diagnosis of sclerosing pancreatitis

Abstract: A swollen main duodenal papilla was a characteristic finding in patients with sclerosing pancreatitis. T-lymphocyte infiltration is present in the swollen main duodenal papilla. These features may be useful in the diagnosis of sclerosing pancreatitis.

Cited by 14 publications

References 0 publications

Clinical practice guidelines for IgG4‐related sclerosing cholangitis

Clinical practice guidelines for IgG4‐related sclerosing cholangitis

IgG4‐related sclerosing cholangitis and autoimmune pancreatitis: Histological assessment of biopsies from Vater's ampulla and the bile duct

Clinical features of isolated proximal‐type immunoglobulin G4‐related sclerosing cholangitis

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