Wagner S, Gebel M, Meier P, Trautwein C, Bleck J, Nashan B, Manns M P
Dept. of Gastroenterology and Hepatology, Medical College of Hanover, Germany.
Endoscopy. 1996 Sep;28(7):546-51. doi: 10.1055/s-2007-1005552.
In a subgroup of patients, primary sclerosing cholangitis (PSC) is complicated by high-grade focal strictures of the bile ducts, and this can have an unfavorable influence on the natural course of the disease. The aim of this study was to evaluate the efficacy and safety of endoscopic treatment in this selected patient group.
Twelve symptomatic patients with primary sclerosing cholangitis and major ductal strictures were included in a prospective study of endoscopic treatment. All patients were managed by repeated angioplasty-type balloon dilation and nasobiliary catheter perfusion. A minimum of two treatment sessions was used, and therapy was continued until satisfactory reopening of the strictures was obtained. Routine endoscopic follow-up was performed after three, six, 12, 18, and 24 months, and then at yearly intervals. The efficacy of therapy was assessed by evaluating clinical symptoms, laboratory data, and cholangiograms.
The long-term follow-up averaged 23 months (range: 12-50 months). Two to nine (mean: three) treatment sessions were required to obtain satisfactory reopening of major biliary strictures. Eight patients showed considerable and sustained improvement. The mean serum bilirubin, alkaline phosphatase, gamma-glutamyl-transpeptidase, and alanine aminotransferase levels felt significantly by 73% (P = 0.0164), 46% (P = 0.0022), 55% (P = 0.0022), and 58% (P = 0.0022), respectively. The average radiographic stricture score before treatment was 3.2 +/- 0.8 (P = 0.0033). Three patients required liver transplantation seven, 12, and 40 months after the initiation of endoscopic treatment, due to a deterioration in hepatic function or an inability to exclude complex biliary malignancy. No major procedure-related side effects were observed.
Our results suggest that the endoscopic treatment of PSC patients with dominant bile duct strictures is effective, safe, and well-tolerated. However, it is important not to overlook the potential development of cholangiocarcinoma.
在一部分患者中，原发性硬化性胆管炎（PSC）并发胆管高度局限性狭窄，这会对疾病的自然病程产生不利影响。本研究的目的是评估内镜治疗在这一特定患者群体中的疗效和安全性。
12例有症状的原发性硬化性胆管炎及主要胆管狭窄患者纳入内镜治疗的前瞻性研究。所有患者均接受重复血管成形术式球囊扩张和鼻胆管灌注治疗。最少进行2次治疗，持续治疗直至狭窄得到满意的再通。在3、6、12、18和24个月后进行常规内镜随访，之后每年随访一次。通过评估临床症状、实验室数据和胆管造影来评估治疗效果。
长期随访平均23个月（范围：12 - 50个月）。需要2至9次（平均3次）治疗才能使主要胆管狭窄得到满意的再通。8例患者有显著且持续的改善。血清胆红素、碱性磷酸酶、γ-谷氨酰转肽酶和丙氨酸转氨酶的平均水平分别显著下降73%（P = 0.0164）、46%（P = 0.0022）、55%（P = 0.0022）和58%（P = 0.0022）。治疗前平均放射学狭窄评分为3.2 ± 0.8（P = 0.0033）。3例患者在内镜治疗开始后7、12和40个月因肝功能恶化或无法排除复杂胆管恶性肿瘤而需要进行肝移植。未观察到与手术相关的重大副作用。
我们的结果表明，内镜治疗原发性硬化性胆管炎合并主要胆管狭窄患者是有效、安全且耐受性良好的。然而，重要的是不要忽视胆管癌的潜在发展。
