Role of endoscopy in primary sclerosing cholangitis: European Society of Gastrointestinal Endoscopy (ESGE) and European Association for the Study of the Liver (EASL) Clinical Guideline

Lars Aabakken; Tom H. Karlsen; Jörg Albert; Marianna Arvanitakis; Olivier Chazouilleres; Jean-Marc Dumonceau; Martti Färkkilä; Peter Fickert; Gideon M.  Hirschfield; Andrea Laghi; Marco Marzioni; Michael Fernandez; Stephen P.  Pereira; Jürgen Pohl; Jan-Werner Poley; Cyriel Y. Ponsioen; Christoph Schramm; Fredrik Swahn; Andrea Tringali; Cesare Hassan

doi:10.1055/s-0043-107029

Endoscopy, Table of Contents

Endoscopy 2017; 49(06): 588-608
DOI: 10.1055/s-0043-107029

Guideline

Role of endoscopy in primary sclerosing cholangitis: European Society of Gastrointestinal Endoscopy (ESGE) and European Association for the Study of the Liver (EASL) Clinical Guideline

Lars Aabakken

¹GI Endoscopy, Rikshospitalet University Hospital, Hospital, and Faculty of Medicine, University of Oslo,Oslo, Norway

,

Tom H. Karlsen

²Norwegian PSC Research Center and Section for Gastroenterology, Department of Transplantation Medicine, Division of Cancer Medicine, Surgery and Transplantation, Oslo University Hospital, Rikshospitalet, and Institute of Clinical Medicine, University of Oslo, Oslo, Norway

,

Jörg Albert

³Abteilung für Gastroenterologie, Hepatologie und Endokrinologie, Robert-Bosch-Krankenhaus, Stuttgart, Germany

,

Marianna Arvanitakis

⁴Department of Gastroenterology, Hepatopancreatology and Digestive Oncology, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium

,

Olivier Chazouilleres

⁵Service d’Hépatologie, Hôpital Saint-Antoine, Assistance Publique – Hôpitaux de Paris, Centre de référence des maladies inflammatoires du foie et des voies biliaires, Filière Maladies Rares du Foie de l’Adulte et de l’Enfant (FILFOIE), UPMC UNIV Paris 06, France

,

Jean-Marc Dumonceau

⁶Gedyt Endoscopy Center, Buenos Aires, Argentina

,

Martti Färkkilä

⁷Department of Gastroenterology, Helsinki University Central Hospital, Helsinki, Finland

,

Peter Fickert

⁸Research Unit for Experimental and Molecular Hepatology, Division of Gastroenterology and Hepatology, Department of Internal Medicine, Medical University of Graz, Austria

,

Gideon M. Hirschfield

⁹National Institute for Health Research (NIHR), Birmingham Liver Biomedical Research Unit (BRU), and Centre for Liver Research, University of Birmingham, Birmingham, United Kingdom

,

Andrea Laghi

¹⁰Pathological Sciences, Sapienza-University, Rome, Italy

,

Marco Marzioni

¹¹Clinic of Gastroenterology and Hepatology, Università Politecnica delle Marche – Ospedali Riuniti University Hospital, Ancona, Italy

,

Michael Fernandez

⁴Department of Gastroenterology, Hepatopancreatology and Digestive Oncology, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium

,

Stephen P. Pereira

¹²Institute for Liver and Digestive Health, University College London, Royal Free Campus, London, UK

,

Jürgen Pohl

¹³Department of Gastroenterology and Interventional Endoscopy, Klinikum Friedrichshain, Berlin, Germany

,

Jan-Werner Poley

¹⁴Department of Gastroenterology and Hepatology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands

,

Cyriel Y. Ponsioen

¹⁵Department of Gastroenterology and Hepatology, Academic Medical Center, Amsterdam, The Netherlands

,

Christoph Schramm

¹⁶Department of Medicine I and Martin Zeitz Centre for Rare Diseases, University Medical Center Hamburg-Eppendorf, Hamburg, Germany

,

Fredrik Swahn

¹⁷Center for Digestive Diseases, Karolinska University Hospital and Division of Surgery, CLINTEC, Karolinska Institute, Stockholm, Sweden

,

Andrea Tringali

¹⁸Digestive Endoscopy Unit, Catholic University, Rome, Italy

,

Cesare Hassan

¹⁹Digestive Endoscopy Unit, Nuovo Regina Margherita Hospital, Rome, Italy

› Author Affiliations

Abstract

MAIN RECOMMENDATIONS

1 ESGE/EASL recommend that, as the primary diagnostic modality for PSC, magnetic resonance cholangiography (MRC) should be preferred over endoscopic retrograde cholangiopancreatography (ERCP).

Moderate quality evidence, strong recommendation.

2 ESGE/EASL suggest that ERCP can be considered if MRC plus liver biopsy is equivocal or contraindicated in patients with persisting clinical suspicion of PSC. The risks of ERCP have to be weighed against the potential benefit with regard to surveillance and treatment recommendations.

Low quality evidence, weak recommendation.

6 ESGE/EASL suggest that, in patients with an established diagnosis of PSC, MRC should be considered before therapeutic ERCP.

Weak recommendation, low quality evidence.

7 ESGE/EASL suggest performing endoscopic treatment with concomitant ductal sampling (brush cytology, endobiliary biopsies) of suspected significant strictures identified at MRC in PSC patients who present with symptoms likely to improve following endoscopic treatment.

Strong recommendation, low quality evidence.

9 ESGE/EASL recommend weighing the anticipated benefits of biliary papillotomy/sphincterotomy against its risks on a case-by-case basis.

Strong recommendation, moderate quality evidence.

Biliary papillotomy/sphincterotomy should be considered especially after difficult cannulation.

Strong recommendation, low quality evidence.

16 ESGE/EASL suggest routine administration of prophylactic antibiotics before ERCP in patients with PSC.

Strong recommendation, low quality evidence.

17 EASL/ESGE recommend that cholangiocarcinoma (CCA) should be suspected in any patient with worsening cholestasis, weight loss, raised serum CA19-9, and/or new or progressive dominant stricture, particularly with an associated enhancing mass lesion.

Strong recommendation, moderate quality evidence.

19 ESGE/EASL recommend ductal sampling (brush cytology, endobiliary biopsies) as part of the initial investigation for the diagnosis and staging of suspected CCA in patients with PSC.

Strong recommendation, high quality evidence.

Full Text

References

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Supplementary material