Diagnosing Biliary Strictures

Yasuki Hori, MD; Suresh T. Chari, MD; Yoshihisa Tsuji, MD, PhD; Naoki Takahashi, MD; Dai Inoue, MD; Phil A. Hart, MD; Takeshi Uehara, MD; Masayasu Horibe, MD; Satoshi Yamamoto, MD; Akira Satou, MD; Lizhi Zhang, MD; Kenji Notohara, MD; Itaru Naitoh, MD; Takahiro Nakazawa, MD

Mayo Clinic Proceedings: Innovations, Quality & Outcomes (Jun 2021)

Diagnosing Biliary Strictures

Yasuki Hori, MD,
Suresh T. Chari, MD,
Yoshihisa Tsuji, MD, PhD,
Naoki Takahashi, MD,
Dai Inoue, MD,
Phil A. Hart, MD,
Takeshi Uehara, MD,
Masayasu Horibe, MD,
Satoshi Yamamoto, MD,
Akira Satou, MD,
Lizhi Zhang, MD,
Kenji Notohara, MD,
Itaru Naitoh, MD,
Takahiro Nakazawa, MD

Affiliations

Yasuki Hori, MD: Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
Suresh T. Chari, MD: Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN
Yoshihisa Tsuji, MD, PhD: Department of General Medicine, Sapporo Medical University, Sapporo, Japan; Correspondence: Address to Yoshihisa Tsuji, MD, PhD, Department of General Medicine, Sapporo Medical University, S1 W17, Chuo-ku, Sapporo 060-8556, Japan.
Naoki Takahashi, MD: Department of Radiology, Mayo Clinic, Rochester, MN
Dai Inoue, MD: Department of Radiology, Kanazawa University Graduate School of Medical Science, Kanazawa, Japan
Phil A. Hart, MD: Division of Gastroenterology, Hepatology, and Nutrition, The Ohio State University Wexner Medical Center, Columbus, OH
Takeshi Uehara, MD: Department of Laboratory Medicine, Shinshu University, Matsumoto, Japan
Masayasu Horibe, MD: Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN
Satoshi Yamamoto, MD: Department of Gastroenterology, Bantane Hospital, Fujita Health University, Nagoya, Japan
Akira Satou, MD: Department of Surgical Pathology, Aichi Medical University Hospital, Nagakute, Japan
Lizhi Zhang, MD: Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN
Kenji Notohara, MD: Department of Anatomic Pathology, Kurashiki Central Hospital, Kurashiki, Japan
Itaru Naitoh, MD: Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
Takahiro Nakazawa, MD: Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan

Journal volume & issue: Vol. 5, no. 3
pp. 535 – 541

Abstract

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Biliary strictures caused by inflammation or fibrosis lead to jaundice and cholangitis which often make it difficult to distinguish malignant strictures. In cases when malignancy cannot be excluded, surgery is often performed. The concept of immunoglobulin G4 (IgG4)–related sclerosing cholangitis (SC) as a benign biliary stricture was recently proposed. The high prevalence of the disease in Asian countries has resulted in multiple diagnostic and treatment guidelines; however, there is need to formulate a standardized diagnostic strategy among various countries considering the utility, invasiveness, and cost-effectiveness. We evaluated accuracies of various diagnostic modalities for biliary strictures comparing pathology in the Delphi meetings which were held in Rochester, MN. The diagnostic utility for each modality was graded according to the experts, including gastroenterologists, endoscopists, radiologists, and pathologists from the United States and Japan. Diagnostic utility of 10 modalities, including serum IgG4 level, noninvasive imaging, endoscopic ultrasound, endoscopic retrograde cholangiopancreatography–related diagnostic procedures were advocated and the reasons were specified. Serum IgG4 level, noninvasive imaging, diagnostic endoscopic ultrasound and intraductal ultrasonography under endoscopic retrograde cholangiopancreatography were recognized as useful modalities for the diagnosis. The information in this article will aid in the diagnosis of biliary strictures particularly for distinguishing IgG4–SC from cholangiocarcinoma and/or primary SC.

Published in Mayo Clinic Proceedings: Innovations, Quality & Outcomes

ISSN: 2542-4548 (Online)
Publisher: Elsevier
Country of publisher: United States
LCC subjects: Medicine: Medicine (General)
Website: https://www.journals.elsevier.com/mayo-clinic-proceedings-innovations-quality-and-outcomes/

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