Cazzagon Nora, Chazouillères Olivier, Corpechot Christophe, El Mouhadi Sanaâ, Chambenois Edouard, Desaint Benoit, Chaput Ulriikka, Lemoinne Sara, Arrivé Lionel
Reference center for inflammatory biliary disease and autoimmune hepatitis (MIVB), Saint-Antoine Hospital, Assistance Publique-Hôpitaux de Paris, AP-HP, 75012 Paris, France; Department of Surgery, Oncology and Gastroenterology (DiSCOG), University of Padova, Padova, Italy.
Reference center for inflammatory biliary disease and autoimmune hepatitis (MIVB), Saint-Antoine Hospital, Assistance Publique-Hôpitaux de Paris, AP-HP, 75012 Paris, France.
Clin Res Hepatol Gastroenterol. 2019 Aug;43(4):387-394. doi: 10.1016/j.clinre.2019.01.003. Epub 2019 Feb 14.
The aim of this study was to identify predictive criteria of improvement after endoscopic treatment (ET) for severe strictures of extrahepatic bile ducts in patients with primary sclerosing cholangitis (PSC).
PSC patients who had at least one ET for severe stricture were included. Features of magnetic resonance cholangiography (MRC), performed before ET, were evaluated according to a standard model of interpretation, and a radiologic qualitative score of probability of improvement after ET was built. Score 3 (likely) was given in case of severe common bile duct (CBD) stricture with marked dilatation without severe strictures of upstream ducts, Score 1 (unlikely) was given in case of severe multiple strictures of secondary ducts without biliary dilatation and Score 2 (undeterminate) was given to an intermediate pattern. The response to ET was assessed at 2 months (T2-response) from the last ET and at 12 months (T12-response) from inclusion.
Thirty-one patients were included. All had severe stricture (reduction ≥ 75% of the diameter) of CBD and 50% had severe stricture of right and/or left hepatic duct (LHD) at MRC before ET. According to the qualitative score, 16 patients had Score 3, 7 had Score 1 and 9 had Score 2. T12-response was obtained in 50% of patients. In univariate analysis, short LHD strictures, bilirubin, transaminases, pruritus and Score 3 were associated with T12-response. Increased bilirubin and transaminases were independent predictive factors of T12-response (HR 24, 95% CI: 3.4-170.4, P = 0.001 and 23.8, 95% CI: 3.4-169.4, P = 0.002, respectively).
MRC, together with biochemical features, may contribute to identify the PSC patients who are likely to be improved after ET for severe strictures of extrahepatic bile ducts.
本研究旨在确定原发性硬化性胆管炎（PSC）患者肝外胆管严重狭窄内镜治疗（ET）后改善的预测标准。
纳入至少接受过一次针对严重狭窄的ET的PSC患者。根据标准解读模型评估ET前进行的磁共振胰胆管造影（MRC）的特征，并建立ET后改善可能性的放射学定性评分。如果肝外胆管严重狭窄伴明显扩张且上游胆管无严重狭窄，则评分为3分（可能）；如果二级胆管严重多发狭窄且无胆管扩张，则评分为1分（不太可能）；中间情况评分为2分（不确定）。在最后一次ET后2个月（T2反应）和纳入后12个月（T12反应）评估ET反应。
纳入31例患者。所有患者在ET前MRC检查时肝外胆管均有严重狭窄（直径缩小≥75%），50%的患者肝右和/或肝左管（LHD）有严重狭窄。根据定性评分，16例患者评分为3分，7例评分为1分，9例评分为2分。50%的患者获得了T12反应。单因素分析显示，LHD短段狭窄、胆红素、转氨酶、瘙痒和评分为3分与T12反应相关。胆红素和转氨酶升高是T12反应的独立预测因素（HR分别为24，95%CI：3.4-170.4，P = 0.001；23.8，95%CI：3.4-169.4，P = 0.002）。
MRC结合生化特征可能有助于识别肝外胆管严重狭窄的PSC患者在接受ET后可能改善的情况。
