PMID- 29055922
OWN - NLM
STAT- MEDLINE
DCOM- 20180129
LR  - 20210928
IS  - 1665-2681 (Print)
IS  - 1665-2681 (Linking)
VI  - 16
IP  - 6
DP  - 2017 November-December,
TI  - Endoscopic Management of Primary Sclerosing Cholangitis.
PG  - 842-850
LID - 10.5604/01.3001.0010.5274 [doi]
AB  - Primary sclerosing cholangitis (PSC) remains a rare but potentially devastating 
      chronic, cholestatic liver disease. PSC causes obstruction of intra- and/or 
      extra-hepatic bile ducts by inflammation and fibrosis, leading to biliary 
      obstruction, cirrhosis and portal hypertension with all associated sequelae. The 
      most dreaded consequence of PSC is cholangiocarcinoma, occurring in 10-20% of 
      patients with PSC, and with population-based estimates of a 398-fold increased 
      risk of cholangiocarcinoma in patients with PSC compared to the general 
      population. We use the 4-D approach to endoscopic evaluation and management of 
      PSC based on currently available evidence. After laboratory testing with liver 
      chemistries and high-quality cross-sectional imaging with MRCP, the first D is 
      Dominant stricture diagnosis and evaluation. Second, Dilation of strictures found 
      during ERCP is performed using balloon dilation to as many segments as possible. 
      Third, Dysplasia and cholangiocarcinoma diagnosis is performed by separated 
      brushings for conventional cytology and fluorescence in situ hybridization 
      (FISH), and consideration for direct cholangioscopy with SpyGlass. Fourt and 
      finally, Dosing of antibiotics is critical to prevent peri-procedural 
      cholangitis. The aim of this review article is to explore endoscopic tools and 
      techniques for the diagnosis and management of PSC and provide a practical 
      approach for clinicians.
FAU - Barkin, Jodie A
AU  - Barkin JA
AD  - University of Miami, Leonard M. Miller School of Medicine, Department of 
      Medicine, Division of Gastroenterology. Miami, Florida, USA.
FAU - Levy, Cynthia
AU  - Levy C
AD  - University of Miami, Leonard M. Miller School of Medicine, Department of 
      Medicine, Division of Hepatology. Miami, Florida, USA.
FAU - Souto, Enrico O
AU  - Souto EO
AD  - University of Miami, Leonard M. Miller School of Medicine, Department of 
      Medicine, Division of Gastroenterology. Miami, Florida, USA.
LA  - eng
PT  - Journal Article
PT  - Review
PL  - Mexico
TA  - Ann Hepatol
JT  - Annals of hepatology
JID - 101155885
RN  - 0 (Anti-Bacterial Agents)
SB  - IM
MH  - Anti-Bacterial Agents/therapeutic use
MH  - *Cholangiopancreatography, Endoscopic Retrograde/adverse effects
MH  - Cholangiopancreatography, Magnetic Resonance
MH  - Cholangitis, Sclerosing/complications/*diagnosis/*surgery
MH  - Dilatation
MH  - Endosonography
MH  - Humans
MH  - In Situ Hybridization, Fluorescence
MH  - Liver Function Tests
MH  - Predictive Value of Tests
MH  - Risk Factors
MH  - Treatment Outcome
OTO - NOTNLM
OT  - Primary sclerosing cholangitis. Dominant stricture. Endoscopy. Management. 
      Endoscopic retrograde cholangiopancreatography
EDAT- 2017/10/23 06:00
MHDA- 2018/01/30 06:00
CRDT- 2017/10/23 06:00
PHST- 2017/10/23 06:00 [entrez]
PHST- 2017/10/23 06:00 [pubmed]
PHST- 2018/01/30 06:00 [medline]
AID - S1665-2681(19)30450-8 [pii]
AID - 10.5604/01.3001.0010.5274 [doi]
PST - ppublish
SO  - Ann Hepatol. 2017 November-December,;16(6):842-850. doi: 
      10.5604/01.3001.0010.5274.