Kubota Kensuke, Kato Shingo, Akiyama Tomoyuki, Yoneda Masato, Fujita Koji, Ogawa Masami, Inamori Masahiko, Kobayashi Noritoshi, Saito Satoru, Kakuta Yukio, Ohshiro Hisashi, Nakajima Atsushi
Division of Gastroenterology, Yokohama Rosai Hospital, Yokohama City University, Graduate School of Medicine, Kanazawa, Yokohama, Japan.
Gastrointest Endosc. 2008 Dec;68(6):1204-8. doi: 10.1016/j.gie.2008.08.013.
Differentiating primary sclerosing cholangitis (PSC) and sclerosing cholangitis caused by autoimmune pancreatitis (SC-AIP) is often challenging. Recently, endoscopic findings of the duodenal papilla in cases with AIP or PSC were reported by Unno and Parlak, although the endoscopic differentiation of these 2 conditions has not yet been fully clarified.
Our purpose was to clarify the endoscopic findings of the duodenal papilla in patients with SC-AIP and those with PSC and to determine criteria for the differentiation of these conditions.
Case series.
Retrospective.
Twenty-seven patients with SC-AIP and 12 patients with PSC who had undergone ERCP were identified from our database. We reviewed these records to determine whether the duodenal papillary findings (swollen papilla/normal papilla/small papilla) might be potentially useful for differentiating SC-AIP and PSC. Immunohistopathological findings for the duodenal papilla were also examined by using immunoglobulin G4 (IgG4) among the infiltrating plasma cells.
ERCP, biopsy specimen taken from duodenal papilla.
The presence of a swollen duodenal papilla with IgG4-positive plasma cells was useful for discriminating SC-AIP from with PSC.
A swollen duodenal papilla was observed in 63% (17/27) of the patients with SC-AIP, whereas there was no swelling of the duodenal papilla of the patients with PSC. A small papilla was recognized in 50% (6/12) of the patients with PSC. IgG4-positive plasma cells in the duodenal papilla were significantly detected in the patients with SC-AIP but not in the patients with PSC.
Single-center study.
Characteristic duodenal endoscopic papillary features in patients with SC-AIP, such as a swollen duodenal papilla and positive immunostaining for IgG4, might be helpful for discriminating this condition from PSC.
鉴别原发性硬化性胆管炎（PSC）和自身免疫性胰腺炎所致硬化性胆管炎（SC-AIP）往往具有挑战性。最近，Unno和Parlak报道了AIP或PSC病例中十二指肠乳头的内镜检查结果，尽管这两种疾病的内镜鉴别尚未完全明确。
我们的目的是明确SC-AIP患者和PSC患者十二指肠乳头的内镜检查结果，并确定鉴别这些疾病的标准。
病例系列。
回顾性研究。
从我们的数据库中识别出27例接受过内镜逆行胰胆管造影（ERCP）的SC-AIP患者和12例PSC患者。我们回顾这些记录，以确定十二指肠乳头的表现（肿大乳头/正常乳头/小乳头）是否可能有助于鉴别SC-AIP和PSC。还通过在浸润的浆细胞中使用免疫球蛋白G4（IgG4）来检查十二指肠乳头的免疫组织病理学表现。
ERCP，取自十二指肠乳头的活检标本。
十二指肠乳头肿大伴IgG4阳性浆细胞对鉴别SC-AIP和PSC有用。
63%（17/27）的SC-AIP患者观察到十二指肠乳头肿大，而PSC患者的十二指肠乳头无肿大。50%（6/12）的PSC患者发现有小乳头。SC-AIP患者的十二指肠乳头中可显著检测到IgG4阳性浆细胞，而PSC患者中未检测到。
单中心研究。
SC-AIP患者十二指肠内镜乳头的特征性表现，如十二指肠乳头肿大和IgG4免疫染色阳性，可能有助于将这种疾病与PSC鉴别开来。
