TY  - JOUR
A1  - Walter, Dirk Henning
A1  - Hartmann, Sylvia
A1  - Herrmann, Eva
A1  - Peveling-Oberhag, Jan Franz-Josef
A1  - Bechstein, Wolf Otto
A1  - Zeuzem, Stefan
A1  - Hansmann, Martin-Leo
A1  - Friedrich-Rust, Mireen
A1  - Albert, Jörg Gerhard
T1  - Eosinophilic cholangitis is a potentially underdiagnosed etiology in indeterminate biliary stricture
T2  - World journal of gastroenterology
N2  - AIM: To investigate presence and extent of eosinophilic cholangitis (EC) as well as IgG4-related disease in patients with indeterminate biliary stricture (IBS).
METHODS: All patients with diagnosis of sclerosing cholangitis (SC) and histopathological samples such as biopsies or surgical specimens at University Hospital Frankfurt from 2005-2015 were included. Histopathological diagnoses as well as further clinical course were reviewed. Tissue samples of patients without definite diagnosis after complete diagnostic work-up were reviewed regarding presence of eosinophilic infiltration and IgG4 positive plasma cells. Eosinophilic infiltration was as well assessed in a control group of liver transplant donors and patients with primary sclerosing cholangitis.
RESULTS: one hundred and thirty-five patients with SC were included. In 10/135 (13.5%) patients, no potential cause of IBS could be identified after complete diagnostic work-up and further clinical course. After histopathological review, a post-hoc diagnosis of EC was established in three patients resulting in a prevalence of 2.2% (3/135) of all patients with SC as well as 30% (3/10) of patients, where no cause of IBS was identified. 2/3 patients with post-hoc diagnosis of EC underwent surgical resection with suspicion for malignancy. Diagnosis of IgG4-related cholangitis was observed in 7/135 patients (5.1%), whereas 3 cases were discovered in post-hoc analysis. 6/7 cases with IgG4-related cholangitis (85.7%) presented with eosinophilic infiltration in addition to IgG4 positive plasma cells. There was no patient with eosinophilic infiltration in the control group of liver transplant donors (n = 27) and patients with primary sclerosing cholangitis (n = 14).
CONCLUSION: EC is an underdiagnosed benign etiology of SC and IBS, which has to be considered in differential diagnosis of IBS.
KW  - Indeterminate biliary stricture
KW  - endoscopy
KW  - endoscopic retrograde cholangiopancreatography
KW  - eosinophilic cholangitis
KW  - bile duct stenosis
KW  - IgG4-related disease
KW  - primary sclerosing cholangitis
Y1  - 2017
UR  - http://publikationen.ub.uni-frankfurt.de/frontdoor/index/index/docId/43013
UR  - https://nbn-resolving.org/urn:nbn:de:hebis:30:3-430137
UR  - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5311093
SN  - 2219-2840
SN  - 1007-9327
N1  - Copyright © The author(s) 1995-2016. Published by Baishideng Publishing Group Inc. All rights reserved. Articles published by this open-access journal are distributed under the terms of the Creative Commons Attribution-Noncommercial (CC BY-NC 4.0) License, which permits use, distribution, and reproduction in any medium, provided the original work is properly cited, the use is non commercial and is otherwise in compliance with the license.
VL  - 23
IS  - 6
SP  - 1044
EP  - 1050
PB  - WJG Press
CY  - Beijing
ER  -