Fujisawa Toshio, Ushio Mako, Takahashi Sho, Yamagata Wataru, Takasaki Yusuke, Suzuki Akinori, Okawa Yoshihiro, Ochiai Kazushige, Tomishima Ko, Ishii Shigeto, Saito Hiroaki, Isayama Hiroyuki
Department of Gastroenterology, Juntendo University Graduate School of Medicine, Tokyo 113-8421 , Japan.
Diagnostics (Basel). 2020 Apr 29;10(5):268. doi: 10.3390/diagnostics10050268.
Primary sclerosing cholangitis (PSC) is characterized by idiopathic biliary stricture followed by progressive cholestasis and fibrosis. When diagnosing PSC, its differentiation from other types of sclerosing cholangitis and cholangiocarcinoma is necessary. The cholangioscopic findings of PSC have not been investigated sufficiently. PSC and IgG4-related sclerosing cholangitis are difficult to distinguish by peroral cholangioscopy (POCS), but POCS is useful for excluding cholangiocarcinoma. POCS findings vary according to the condition and stage of disease. In the active phase, findings such as mucosal erythema, ulceration, fibrinous white exudate, and an irregular surface are observed and may reflect strong inflammation in the biliary epithelium. On the other hand, findings such as scarring, pseudodiverticula, and bile duct stenosis appear in the chronic phase and may reflect fibrosis and stenosis resulting from repeated inflammation. Observation of inside the bile duct by POCS might confirm the current PSC activity. Because POCS offers not only information regarding the diagnosis of PSC and PSC-associated cholangiocarcinoma but also the current statuses of biliary inflammation and stenosis, POCS could significantly contribute to the diagnosis and treatment of PSC once the characteristic findings of PSC are confirmed by future studies.
原发性硬化性胆管炎（PSC）的特征是特发性胆管狭窄，随后出现进行性胆汁淤积和纤维化。诊断PSC时，有必要将其与其他类型的硬化性胆管炎和胆管癌进行鉴别。PSC的胆管镜检查结果尚未得到充分研究。PSC和IgG4相关性硬化性胆管炎通过经口胆管镜检查（POCS）难以区分，但POCS有助于排除胆管癌。POCS的检查结果因疾病的状况和阶段而异。在活动期，可观察到黏膜红斑、溃疡、纤维蛋白性白色渗出物和表面不规则等表现，这些可能反映胆管上皮的强烈炎症。另一方面，瘢痕形成、假性憩室和胆管狭窄等表现出现在慢性期，可能反映反复炎症导致的纤维化和狭窄。通过POCS观察胆管内部情况可能有助于确认当前PSC的活动状态。由于POCS不仅能提供有关PSC和PSC相关胆管癌诊断的信息，还能提供胆管炎症和狭窄的当前状态，一旦未来研究确认了PSC的特征性表现，POCS可能会对PSC的诊断和治疗做出重大贡献。
