Background and Study Aims: Antimitochondrial antibody (AMA)-negative primary biliary cirrhosis (PBC) has been
difficult to diagnose. Laparoscopic features of AMA-negative PBC were evaluated in
comparison with those of AMA-positive PBC and autoimmune hepatitis.
Patients and Methods: 71 patients who fulfilled the diagnostic criteria for PBC were enrolled in the study;
48 were AMA-positive and 23 were AMA-negative. As a disease control, 46 autoimmune
hepatitis patients were included. Both the frequency and specificity of each laparoscopic
finding were evaluated. A laparoscopic scoring system was introduced, which used,
common and uncommon laparoscopic findings, and was evaluated for the diagnosis of
AMA-negative PBC.
Results: The characteristic laparoscopic findings for AMA-positive PBC were yellowish-white
marking (92 %), dark-brown discoloration (73 %), gentle undulation (67 %), reddish
patch (38 %), and yellowish-white nodules (32 %). On the other hand, laparoscopic
findings such as trench-like depression, reddish markings, and wide and small depressions
were uncommon in PBC compared with autoimmune hepatitis. The frequencies of characteristic
and uncommon laparoscopic findings did not differ statistically between AMA-positive
and AMA-negative PBC, but were different between AMA-positive or AMA-negative PBC
and autoimmune hepatitis. Scores based on common and uncommon laparoscopic findings
were 5.5 ± 1.5 (mean ± SD) in AMA-positive PBC, 5.6 ± 2.0 in AMA-negative PBC, and
- 0.30 ± 0.5 in autoimmune hepatitis.
Conclusion: The laparoscopic findings in AMA-negative PBC did not differ from those of AMA-positive
PBC. A laparoscopic scoring system may be helpful in the diagnosis of AMA-negative
PBC.
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K. Yamamoto, M.D.
First Department of Internal Medicine · Okayama University Medical School
2-5-1 Shikata-cho · Okayama 700-8558 · Japan
Fax: + 81-86-2255991
Email: kazuhide@meews1.med.okayama-u.ac.jp