Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Endosc. Feb 16, 2019; 11(2): 84-94
Published online Feb 16, 2019. doi: 10.4253/wjge.v11.i2.84
Role of endoscopy in the management of primary sclerosing cholangitis
Neil Bharat Marya, James H Tabibian
Neil Bharat Marya, Vatche and Tamar Manoukian Division of Digestive Diseases, UCLA Gastroenterology Fellowship Training Program, Los Angeles, CA 90095, United States
James H Tabibian, Division of Gastroenterology, Department of Medicine, Olive View-UCLA Medical Center, Sylmar, CA 91342, United States
Author contributions: Marya NB reviewed the literature review for relevant original studies and other content; Marya NB selected and/or formatted the figures; Tabibian JH reviewed the figures; Marya NB drafted the manuscript; Tabibian JH provided critical input; all authors approved of the manuscript.
Conflict-of-interest statement: The authors have no financial disclosures or conflicts of interest.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Corresponding author: James H Tabibian, MD, PhD, Health Sciences Clinical Associate Professor, David Geffen School of Medicine at UCLA, Director of Endoscopy, Department of Medicine, Olive View-UCLA Medical Center, 14445 Olive View Drive, Sylmar, CA91342, United States.
Telephone: +1-747-2103205 Fax: +1-747-2104573
Received: November 28, 2018
Peer-review started: December 7, 2018
First decision: December 17, 2018
Revised: January 15, 2019
Accepted: January 30, 2019
Article in press: January 30, 2019
Published online: February 16, 2019

Primary sclerosing cholangitis (PSC) is a rare but prominent fibroinflammatory cholangiopathy which can affect individuals of essentially any age. It carries a median survival of 15-20 years, regardless of age at diagnosis, and is a foremost risk factor for cholangiocarcinoma. Given the chronic and progressive nature of PSC, its inherent risk for biliary tract and other complications, and the paucity of effective pharmacotherapies, endoscopy plays a major role in the care of many patients with this disorder. In this review, we discuss the endoscopic management of PSC, including established and evolving approaches to the diagnosis and treatment of its benign as well as malignant sequelae. Owing to the rarity of PSC and dearth of high-quality evidence, we propose pragmatic approaches based on both currently available data and expert opinion.

Keywords: Bile duct diseases, Cholangiocarcinoma, Inflammatory bowel disease, Endoscopic retrograde cholangiopancreatography, Biopsy, Primary sclerosing cholangitis

Core tip: Primary sclerosing cholangitis is a chronic, inflammatory condition of the biliary tract associated with several biliary and extrabiliary complications requiring endoscopic evaluation, treatment, and surveillance.