Medical Department III (Gastroenterology, Hepatology, and Metabolic Diseases), University Hospital Aachen (RWTH), Aachen, Germany.
Endoscopy. 2012 Oct;44(10):934-9. doi: 10.1055/s-0032-1309896. Epub 2012 Jul 2.
Primary sclerosing cholangitis (PSC) is a rare, chronic cholestatic liver disease, which typically affects middle-aged men and is frequently associated with inflammatory bowel disease. Early recognition and accurate diagnosis remains a clinical challenge. Invasive diagnostic procedures, such as endoscopic retrograde cholangiography or liver biopsy are needed when magnetic resonance cholangiopancreatography remains inconclusive. As these procedures are associated with significant risks, the current study sought to determine whether endoscopic ultrasound (EUS) of the biliary tract is a useful diagnostic tool in cases of suspected PSC.
In a prospective pilot study, 138 patients presenting with chronic cholestatic hepatopathy were screened and 32 patients with possible PSC were evaluated further. In addition to all routine measures, EUS was included in the diagnostic work-up. The following parameters were evaluated and compared with the definitive diagnosis: wall thickening ( ≥ 1.5 mm), irregular wall structure, significant changes of caliber of the common bile duct, and perihilar lymphadenopathy.
In the 138 patients screened, a PSC prevalence of 13 % was found. Of the 32 patients included in the study, 17 had large-duct PSC diagnosed. When two of the aforementioned four parameters showed PSC-like features, sensitivity and specificity of predicting PSC were 76.4 % and 100 %, with positive and negative predictive values of 100 % and 79 %, respectively. In four patients presenting with strictly intrahepatic disease, EUS was not diagnostic.
EUS proved to be a valuable tool in suspected PSC and accurately predicted extrahepatic disease. EUS should be evaluated further as an early procedure in routine diagnostic measurements. This approach promises a significant improvement in disease detection as well as a reduction in high risk invasive procedures.
原发性硬化性胆管炎（PSC）是一种罕见的慢性胆汁淤积性肝病，通常影响中年男性，常与炎症性肠病有关。早期识别和准确诊断仍然是一个临床挑战。当磁共振胰胆管成像（MRCP）结果不确定时，需要进行有创性诊断程序，如内镜逆行胰胆管造影或肝活检。由于这些程序存在显著风险，本研究旨在确定胆道内镜超声（EUS）在疑似 PSC 病例中是否是一种有用的诊断工具。
在一项前瞻性试点研究中，对 138 例表现为慢性胆汁淤积性肝病史的患者进行了筛查，对 32 例疑似 PSC 的患者进行了进一步评估。除了所有常规措施外，还将 EUS 纳入诊断性检查。评估并比较了以下参数与明确诊断：管壁增厚（≥1.5 毫米）、管壁结构不规则、胆总管直径显著变化和肝门周围淋巴结肿大。
在筛查的 138 例患者中，发现 PSC 的患病率为 13%。在纳入研究的 32 例患者中，有 17 例被诊断为大导管 PSC。当上述四个参数中的两个表现出 PSC 样特征时，预测 PSC 的敏感性和特异性分别为 76.4%和 100%，阳性预测值和阴性预测值分别为 100%和 79%。在 4 例表现为严格的肝内疾病的患者中，EUS 无诊断价值。
EUS 被证明是疑似 PSC 的有价值工具，可准确预测肝外疾病。EUS 应作为常规诊断测量中的早期程序进一步评估。这种方法有望显著提高疾病检出率，并减少高风险的有创性程序。
