Abstract
Six jaundiced patients with primary sclerosing cholangitis and a dominant biliary stricture were managed by endoscopic placement of endoprostheses. Five showed considerable improvement within weeks of stenting: their serum bilirubin concentration fell from mean (range) 266 mumol/l (63-681) to 65 mumol/l (10-280) after one month. One patient required a liver transplant at five months because of continued deterioration in hepatic function. Follow up of 12-49 months in the remaining five patients shows sustained biochemical improvement, with repeat cholangiograms indicating doubling of the minimum calibre of the extrahepatic bile duct in four patients and considerable shortening of stricture length in three. Three patients developed sepsis at the time of the initial endoprosthesis insertion: surgical drainage was necessary in one. Endoscopic methods of improving biliary-enteric drainage in jaundiced patients with primary sclerosing cholangitis may be preferable to surgical and percutaneous methods, which may complicate subsequent liver transplantation.
Full text
PDF




Images in this article
Selected References
These references are in PubMed. This may not be the complete list of references from this article.
- Allison M. C., Burroughs A. K., Noone P., Summerfield J. A. Biliary lavage with corticosteroids in primary sclerosing cholangitis. A clinical, cholangiographic and bacteriological study. J Hepatol. 1986;3(1):118–122. doi: 10.1016/s0168-8278(86)80155-6. [DOI] [PubMed] [Google Scholar]
- Cameron J. L., Gayler B. W., Herlong H. F., Maddrey W. C. Sclerosing cholangitis: biliary reconstruction with Silastic transhepatic stents. Surgery. 1983 Aug;94(2):324–330. [PubMed] [Google Scholar]
- Cameron J. L., Pitt H. A., Zinner M. J., Herlong H. F., Kaufman S. L., Boitnott J. K., Coleman J. Resection of hepatic duct bifurcation and transhepatic stenting for sclerosing cholangitis. Ann Surg. 1988 May;207(5):614–622. doi: 10.1097/00000658-198805000-00016. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Chapman R. W., Arborgh B. A., Rhodes J. M., Summerfield J. A., Dick R., Scheuer P. J., Sherlock S. Primary sclerosing cholangitis: a review of its clinical features, cholangiography, and hepatic histology. Gut. 1980 Oct;21(10):870–877. doi: 10.1136/gut.21.10.870. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Escourrou J., Cordova J. A., Lazorthes F., Frexinos J., Ribet A. Early and late complications after endoscopic sphincterotomy for biliary lithiasis with and without the gall bladder 'in situ'. Gut. 1984 Jun;25(6):598–602. doi: 10.1136/gut.25.6.598. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Grijm R., Huibregtse K., Bartelsman J., Mathus-Vliegen E. M., Dekker W., Tytgat G. N. Therapeutic investigations in primary sclerosing cholangitis. Dig Dis Sci. 1986 Aug;31(8):792–798. doi: 10.1007/BF01296045. [DOI] [PubMed] [Google Scholar]
- Hamilton I., Soutar J. S., Bouchier I. A., Cuschieri A. Short-term biliary dilatation and stenting in primary sclerosing cholangitis. J Clin Gastroenterol. 1987 Feb;9(1):70–75. doi: 10.1097/00004836-198702000-00018. [DOI] [PubMed] [Google Scholar]
- Helzberg J. H., Petersen J. M., Boyer J. L. Improved survival with primary sclerosing cholangitis. A review of clinicopathologic features and comparison of symptomatic and asymptomatic patients. Gastroenterology. 1987 Jun;92(6):1869–1875. doi: 10.1016/0016-5085(87)90618-4. [DOI] [PubMed] [Google Scholar]
- Huibregtse K., Tytgat G. N. Palliative treatment of obstructive jaundice by transpapillary introduction of large bore bile duct endoprosthesis. Gut. 1982 May;23(5):371–375. doi: 10.1136/gut.23.5.371. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Johnson G. K., Geenen J. E., Venu R. P., Hogan W. J. Endoscopic treatment of biliary duct strictures in sclerosing cholangitis: follow-up assessment of a new therapeutic approach. Gastrointest Endosc. 1987 Feb;33(1):9–12. doi: 10.1016/s0016-5107(87)71475-8. [DOI] [PubMed] [Google Scholar]
- Kaplan M. M., Arora S., Pincus S. H. Primary sclerosing cholangitis and low-dose oral pulse methotrexate therapy. Clinical and histologic response. Ann Intern Med. 1987 Feb;106(2):231–235. doi: 10.7326/0003-4819-106-2-231. [DOI] [PubMed] [Google Scholar]
- Krige J. E., Terblanche J., Harries-Jones E. P., Bornman P. C. Primary sclerosing cholangitis: biliary drainage and duct dilatation. Br J Surg. 1987 Jan;74(1):54–57. doi: 10.1002/bjs.1800740117. [DOI] [PubMed] [Google Scholar]
- LaRusso N. F., Wiesner R. H., Ludwig J., MacCarty R. L., Beaver S. J., Zinsmeister A. R. Prospective trial of penicillamine in primary sclerosing cholangitis. Gastroenterology. 1988 Oct;95(4):1036–1042. doi: 10.1016/0016-5085(88)90180-1. [DOI] [PubMed] [Google Scholar]
- LaRusso N. F., Wiesner R. H., Ludwig J., MacCarty R. L. Current concepts. Primary sclerosing cholangitis. N Engl J Med. 1984 Apr 5;310(14):899–903. doi: 10.1056/NEJM198404053101407. [DOI] [PubMed] [Google Scholar]
- Lebovics E., Palmer M., Woo J., Schaffner F. Outcome of primary sclerosing cholangitis. Analysis of long-term observation of 38 patients. Arch Intern Med. 1987 Apr;147(4):729–731. [PubMed] [Google Scholar]
- Leiser A., Kadish U. Beneficial effect of colchicine in a case of sclerosing cholangitis. Am J Med Sci. 1986 Jun;291(6):416–418. doi: 10.1097/00000441-198606000-00008. [DOI] [PubMed] [Google Scholar]
- Marsh J. W., Jr, Iwatsuki S., Makowka L., Esquivel C. O., Gordon R. D., Todo S., Tzakis A., Miller C., Van Thiel D., Starzl T. E. Orthotopic liver transplantation for primary sclerosing cholangitis. Ann Surg. 1988 Jan;207(1):21–25. doi: 10.1097/00000658-198801000-00005. [DOI] [PMC free article] [PubMed] [Google Scholar]
- May G. R., Bender C. E., LaRusso N. F., Wiesner R. H. Nonoperative dilatation of dominant strictures in primary sclerosing cholangitis. AJR Am J Roentgenol. 1985 Nov;145(5):1061–1064. doi: 10.2214/ajr.145.5.1061. [DOI] [PubMed] [Google Scholar]
- Mueller P. R., vanSonnenberg E., Ferrucci J. T., Jr, Weyman P. J., Butch R. J., Malt R. A., Burhenne H. J. Biliary stricture dilatation: multicenter review of clinical management in 73 patients. Radiology. 1986 Jul;160(1):17–22. doi: 10.1148/radiology.160.1.3715030. [DOI] [PubMed] [Google Scholar]
- Pitt H. A., Thompson H. H., Tompkins R. K., Longmire W. P., Jr Primary sclerosing cholangitis: results of an aggressive surgical approach. Ann Surg. 1982 Sep;196(3):259–268. doi: 10.1097/00000658-198209000-00004. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Roberts M. S., Pinson C. W., Karlson C., Stone M., Rohrer R., Jenkins R. L. Predictors of intraoperative death and long-term survival in liver transplantation: a multistage analysis. Transplant Proc. 1989 Feb;21(1 Pt 2):2439–2442. [PubMed] [Google Scholar]
- Russell E., Yrizarry J. M., Huber J. S., Nunez D., Jr, Hutson D. G., Schiff E., Reddy K. R., Jeffers L. J., Williams A. Percutaneous transjejunal biliary dilatation: alternate management for benign strictures. Radiology. 1986 Apr;159(1):209–214. doi: 10.1148/radiology.159.1.3952308. [DOI] [PubMed] [Google Scholar]
- Siegel J. H., Guelrud M. Endoscopic cholangiopancreatoplasty: hydrostatic balloon dilation in the bile duct and pancreas. Gastrointest Endosc. 1983 May;29(2):99–103. doi: 10.1016/s0016-5107(83)72540-x. [DOI] [PubMed] [Google Scholar]
- Skolkin M. D., Alspaugh J. P., Casarella W. J., Chuang V. P., Galambos J. T. Sclerosing cholangitis: palliation with percutaneous cholangioplasty. Radiology. 1989 Jan;170(1 Pt 1):199–206. doi: 10.1148/radiology.170.1.2462261. [DOI] [PubMed] [Google Scholar]
- Thompson J. S., Wood R. P., Burnett D. A., Shaw B. W., Jr, Rikkers L. F. The role of nontransplant procedures for sclerosing cholangitis. Am J Surg. 1988 Dec;156(6):506–508. doi: 10.1016/s0002-9610(88)80540-3. [DOI] [PubMed] [Google Scholar]
- Tinckler L. Primary sclerosing cholangitis. Postgrad Med J. 1971 Oct;47(552):666–670. doi: 10.1136/pgmj.47.552.666. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Wiesner R. H., Grambsch P. M., Dickson E. R., Ludwig J., MacCarty R. L., Hunter E. B., Fleming T. R., Fisher L. D., Beaver S. J., LaRusso N. F. Primary sclerosing cholangitis: natural history, prognostic factors and survival analysis. Hepatology. 1989 Oct;10(4):430–436. doi: 10.1002/hep.1840100406. [DOI] [PubMed] [Google Scholar]
- Wood R. A., Cuschieri A. Is sclerosing cholangitis complicating ulcerative colitis a reversible condition? Lancet. 1980 Oct 4;2(8197):716–718. doi: 10.1016/s0140-6736(80)91935-2. [DOI] [PubMed] [Google Scholar]

