Background and Study Aims: Primary sclerosing cholangitis (PSC) is a cholestatic disease characterized by segmental narrowing and dilatation of bile ducts. Few studies have been performed on the laparoscopic findings associated with this disease, and the present study was intended to assess the usefulness of laparoscopy for the diagnosis and staging of PSC.
Patients and Methods: Six patients were examined by laparoscopy with liver biopsy. Repeated laparoscopy was performed in three patients.
Results: Laparoscopy revealed coarse surface irregularity and discoloration. Surface irregularity was classified into four grades: smooth, shallowly depressed, undulated, and nodular. The affected area showed whitish yellow discoloration. The discolored area was demonstrated as a poorly stained area by intravenous injection of indocyanine green (ICG). Lobular markings became apparent because of the yellow color change in the portal tract, resulting in a leopardskin-like appearance. Lymph-vessel dilatation was seen in advanced stages. Repeated laparoscopy of a patient without treatment demonstrated a progression from a smooth surface to a shallow depression with leopardskin-like markings. On the other hand, the two patients treated with immunosuppressive agents showed improvement of liver swelling and disappearance of the leopardskin-like markings and lymph-vessel dilatation.
Conclusions: Laparoscopy may provide useful information for the diagnosis and staging of PSC.
References
1 Wiesner R H, Porayko M K, LaRusso N F, et al. Primary sclerosing cholangitis. In: Schiff L, Schiff ER (eds). Diseases of the liver. 7th edition. Philadelphia; Lippincott, 1993: 411-426
3
Okada H, Mizuno M, Yamamoto K, et al.
Primary sclerosing cholangitis in Japanese patients: association with inflammatory bowel disease.
Acta Med Okayama.
1996;
50
227-235
8
Olsson R, Hagerstrand I, Broome U, et al.
Sampling variability of percutaneous liver biopsy in primary sclerosing cholangitis.
J Clin Pathol.
1995;
48
933-935
9
Ito T, Ukida M, Yamamoto K, et al.
Diagnostic accuracy of laparoscopic liver biopsy in chronic liver diseases, comparison of laparoscopic and US-guided liver biopsy results.
Dig Endosc.
1995;
7
261-265
11
Tanimizu M, Ukida M, Ito T, et al.
Peritoneoscopic findings of autoimmune hepatitis - comparison of hepatitis C virus negative autoimmune hepatitis and hepatitis C virus positive autoimmune hepatitis.
Dig Endosc.
1994;
6
170-175
13
Minami Y, Seki K, Nishikawa M, et al.
Laparoscopic findings of the liver in the diagnosis of primary biliary cirrhosis: “reddish patch”, a laparoscopic feature in asymptomatic stage.
Endoscopy.
1982;
14
203-208
14
Onji M, Yamashita Y, Kato T, et al.
Laparoscopic histopathological analysis of “gentle undulation” findings observed in patients with primary biliary cirrhosis.
Endoscopy.
1987;
19
17-19
17
Ito T, Itoshima T, Ukida M, et al.
Peritoneoscopy of the liver stained by intravenous injection of indocyanine green - experimental and clinical studies.
Gastroenterol Jpn.
1983;
18
593-598
18
Ito T, Ukida M, Yamamoto K, et al.
Repeated laparoscopy of 27 patients with chronic non-A, non-B hepatitis showing a complete response to IFN therapy.
Dig Endosc.
1992;
4
327-333