Endoscopic management of primary sclerosing cholangitis: review, and report of an open series.

Of the multiple treatment options available to physicians managing patients with primary sclerosing cholangitis (PSC), no single form of therapy has proven to be efficacious or to improve the clinical outcome of affected patients. Surgical and radiological methods require multiple procedures which are associated with increased morbidity, the most serious being sepsis. Endoscopic therapy is safer and easier to perform, and has been shown to provide symptomatic as well as objective improvement in affected patients. It, too, is associated with some complications, although less serious than other alternative treatments, but it is not effective in protracted disease. The potential of overlooking or missing cholangiocarcinoma is more apparent when nonsurgical techniques are employed. In this review we will discuss the various endoscopic treatment modalities utilized in PSC disease, and include the results that have been obtained with these techniques since they were incorporated into our armamentarium in 1983.