Document Detail


Endoscopic approaches for the diagnosis of autoimmune pancreatitis.
MedLine Citation:
PMID:  25115499     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
Autoimmune pancreatitis (AIP) is characterized by diffuse pancreatic enlargement and irregular narrowing of the main pancreatic duct (MPD). IgG4-related sclerosing cholangitis (IgG4-SC) associated with AIP frequently appears as a bile duct stricture. Therefore, it is important to differentiate AIP and IgG4-SC from pancreatic cancer and cholangiocarcinoma or primary sclerosing cholangitis, respectively. Endoscopy plays a central role in the diagnosis of AIP and IgG4-SC, because it provides imaging of the MPD and bile duct strictures as well as the ability to obtain tissue samples for histological evaluations. Diffuse irregular narrowing of MPD on endoscopic retrograde cholangiopancreatography (ERCP) is rather specific to AIP, but localized narrowing of the MPD is often difficult to differentiate from MPD stenosis caused by pancreatic cancer. A long stricture (>1/3 the length of the MPD) and lack of upstream dilatation from the stricture (<5mm) might be key features of AIP on ERCP. Some cholangiographic features, such as segmental strictures, strictures of the lower bile duct, and long strictures with prestenotic dilatation, are more common in IgG4-SC than in cholangiocarcinoma. Intraductal ultrasonography with ERCP provides high resolution images of the bile duct wall that can be used to discriminate IgG4-SC from cholangiocarcinoma. Endoscopic ultrasonography (EUS) reveals diffuse hypoechoic pancreatic enlargement, sometimes with hypoechoic inclusions, in patients with AIP. In addition, EUS-elastography and contrast-enhanced harmonic EUS have been developed with promising results. The usefulness of EUS-guided fine needle aspiration has been increasingly recognized for obtaining adequate tissue samples for the histological diagnosis of AIP. Further improvement of endoscopic procedures and devices will contribute to more accurate diagnosis of AIP and IgG4-SC.
Authors:
Atsushi Kanno; Atsushi Masamune; Tooru Shimosegawa
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2014-8-13
Journal Detail:
Title:  Digestive endoscopy : official journal of the Japan Gastroenterological Endoscopy Society     Volume:  -     ISSN:  1443-1661     ISO Abbreviation:  Dig Endosc     Publication Date:  2014 Aug 
Date Detail:
Created Date:  2014-8-13     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9101419     Medline TA:  Dig Endosc     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
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This article is protected by copyright. All rights reserved.
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