Modha Kunjam, Navaneethan Udayakumar
Kunjam Modha, Udayakumar Navaneethan, Digestive Disease Institute, the Cleveland Clinic, Cleveland, OH 44195, United States.
World J Hepatol. 2015 Apr 18;7(5):799-805. doi: 10.4254/wjh.v7.i5.799.
Primary sclerosing cholangitis (PSC) is a chronic, cholestatic liver condition characterized by inflammation, fibrosis, and destruction of the intra- and extrahepatic bile ducts. The therapeutic endoscopist plays a key role in the diagnosis and management of PSC. In patients presenting with a cholestatic profile, endoscopic retrograde cholangiopancreatography (ERCP) is warranted for a definite diagnosis of PSC. Dominant strictures of the bile duct occur in 36%-57% of PSC patients. Endoscopic balloon dilatation with or without stenting have been employed in the management of dominant strictures. In addition, PSC patients are at increased risk of developing cholangiocarcinoma with a 20% lifetime risk. Brush cytology obtained during ERCP and use of fluorescence in situ hybridization forms the initial diagnostic step in the investigation of patients with dominant biliary strictures. Our review aims to summarize the current evidence supporting the role of a therapeutic endoscopist in the management of PSC patients.
原发性硬化性胆管炎（PSC）是一种慢性胆汁淤积性肝病，其特征为肝内和肝外胆管的炎症、纤维化及破坏。治疗内镜医师在PSC的诊断和管理中起着关键作用。对于表现出胆汁淤积特征的患者，内镜逆行胰胆管造影（ERCP）对于PSC的明确诊断是必要的。36%-57%的PSC患者会出现胆管的主导性狭窄。内镜下球囊扩张术（无论是否置入支架）已被用于主导性狭窄的治疗。此外，PSC患者发生胆管癌的风险增加，终生风险为20%。在ERCP过程中获取的刷检细胞学检查以及荧光原位杂交技术的应用，构成了对主导性胆管狭窄患者进行调查的初始诊断步骤。我们的综述旨在总结目前支持治疗内镜医师在PSC患者管理中作用的证据。
