Fateen W, Taylor N, James MW

Language: English
References: 4
Page: 330-331
PDF size: 4791.62 Kb.

Text Extraction

CASE REPORT

A 77 years old male patient presented five years earlier with painless jaundice and symptomatic cholangitis requiring hospital admission. He was fit and well otherwise. An endoscopic retrograde cholangio-pancreatography (ERCP) showed intra- and extra-hepatic biliary stricturing and beading suggestive of sclerosing cholangitis. No apparent triggers such as gallstones or inflammatory pancreatitis were identified, and he had no other systemic symptoms. He continued to suffer from recurrent attacks of cholangitis despite treatment with ursodeoxycholic acid 500 mg twice daily (14 mg/kg). This was mostly managed at home using short courses of oral antibiotics. He subsequently developed recurring symptoms of lethargy, itching and loss of appetite which resulted in 5.5 kg weight loss. This required further hospitalization three years after the initial presentation. Bilirubin levels were mostly normal and alkaline phosphatase approximately twice the upper limit of normal. A magnetic resonance cholangio-pancreatography (1.5 Tesla MRCP) showed a new 3 cm long common hepatic duct (CHD) indeterminate stricture near the hilum along with sclerosing cholangitis- related features previously demonstrated on ERCP. Blood CA19.9 was 58kU/L (normal range 0-27) and IgG4 levels were normal. EUS showed a 10 mm hilar lymph node with benign cytology using 25G FNA. He was referred to our unit for further cholangioscopic characterisation using single operator peroral cholangioscopy (SOPC; Spyglass DS^® Boston Scientific).

REFERENCES

1. European Society of Gastrointestinal Endoscopy; European Association for the study of the Liver. 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. J Hepatol 2017; 66: 1265-81. doi: 10.1016/j.jhep.2017.02.013.

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