Editorial
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Endosc. Aug 10, 2015; 7(10): 920-927
Published online Aug 10, 2015. doi: 10.4253/wjge.v7.i10.920
What is the current role of endoscopy in primary sclerosing cholangitis?
Benjamin Tharian, Nayana Elizabeth George, Tony Chiew Keong Tham
Benjamin Tharian, Center for Interventional Endoscopy, Florida Hospital, Orlando, FL 32803, United States
Nayana Elizabeth George, Western Hospital, Melbourne, Victoria 3011, Australia
Tony Chiew Keong Tham, Division of Gastroenterology, Ulster Hospital, N Ireland, BT16 1RH Belfast, United Kingdom
Author contributions: All authors contributed to this manuscript.
Conflict-of-interest statement: None owns patent or any conflict 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: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Dr. Benjamin Tharian, MD, MRCP (UK), Gastro FRACP, Advanced Endoscopy Fellow, Center for Interventional Endoscopy, Florida Hospital, 601 East Rollins Drive, Orlando, FL 32803, United States. benjamintharian@yahoo.co.in
Telephone: +1-407-2270144 Fax: +1-407-3032585
Received: January 6, 2015
Peer-review started: January 7, 2015
First decision: March 6, 2015
Revised: March 21, 2015
Accepted: July 11, 2015
Article in press: July 14, 2015
Published online: August 10, 2015
Abstract

Endoscopy has important roles in the management of primary sclerosing cholangitis (PSC), ranging from narrowing down the differential diagnoses, screening for complications, determining prognosis and therapy. While the need for a diagnostic endoscopic retrograde cholangiopancreatography (ERCP) may be obviated by a positive magnetic resonance cholangiopancreatography (MRCP), a negative MRCP does not exclude PSC and may therefore necessitate an ERCP, which is traditionally regarded as the gold standard. In this editorial we have not covered the endoscopic management of inflammatory bowel disease in the context of PSC nor of endoscopic surveillance and treatment of portal hypertension complicating PSC.

Keywords: Sclerosing cholangitis, Endoscopic retrograde cholangiopancreatography, Endosonography, Cholangiocarcinoma, Stents, Fluorescence in situ hybridization technique, Biochemical markers

Core tip: Primary sclerosing cholangitis is a cholestatic disease of unclear etiopathogenesis, often seen in association with inflammatory bowel disease. It is characterized by fibrosis of the intra and extra hepatic bile ducts, resulting in stricturing disease, predisposing to cholangiocarcinoma. Diagnosis requires a high index of clinical suspicion and is often made by magnetic resonance cholangiopancreatography in the appropriate clinical context, although endoscopic retrograde cholangiopancreatography remains the gold standard. The latter being invasive is seldom used as a diagnostic modality and is reserved for management of complications including dilatation and stenting of dominant and anastomotic strictures, brush cytology and for SpyGlass Cholangioscopy.