The authors reply:
We agree with Valente and colleagues on the need for better tests to improve the early detection of cholangiocarcinoma among patients with primary sclerosing cholangitis. ERCP-guided SOPC and pCLE are promising diagnostic tools.1,2 In our view, however, technical issues and limited expertise, along with the fact that these tools are available only in specialized medical centers, limit the likelihood of widespread use at this time.
We thank Noroski and Fuleihan for their comments on the hyper-IgM syndrome as a cause of cryptosporidium-induced secondary sclerosing cholangitis. However, to put that diagnosis in perspective, it is worth noting that only about 6% of patients with this rare syndrome (about 1 in 500,000 people) will have cryptosporidium infections that may cause secondary sclerosing cholangitis.3
Footnotes
Since publication of their article, the authors report no further potential conflict of interest.
References
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