GASTROENTEROLOGY ARTICLE OF THE WEEK
March 22, 2007
Charatcharoenwitthaya P, Lindor K. Primary sclerosing cholangitis with a rising alkaline phosphatase at annual follow-up. Clin Gastroenterol Hepatol 2007;5:32-36.
1. Cholangiocarcinoma
a. Develops only after PSC -cirrhosis is established
b. Risk increases with duration of PSC or IBD
c. About 5% are multifocal
d. The most common location is perihilar
e. Percutaneous biopsy of a potentially resectable cholangiocarcinoma should be obtained prior to surgery to confirm the diagnosis
True or False
2. Dr. Farmer can pronounce the last name of the first author of this article 5 times in a row without problems.
3. Patients with PSC and no cirrhosis are at a very low risk for developing cholangiocarcinoma
4. Brush cytology at ERCP is a sensitive and specific way to diagnose cholangiocarcinoma
5. In patients with PSC, fever may occur in the absence of cholangitis and resolves spontaneously
6. The presence of abdominal lymphadenopathy in PSC patients is highly suggestive of cholangiocarcinoma
7. IBD is present in 95% of patients with PSC
8. Lack of symptoms at diagnosis predict mild involvement of bile ducts at cholangiography
9. An episode of cholangitis in a PSC patient with no recent cholangiography is an indication for imaging the biliary system
10. Patients with PSC should be monitored with serial CEA and CA 19-9 levels to detect development of cholangiocarcinoma
11. PET Scan is emergency as the modality of choice to diagnose early cholangiocarcinoma
12. CT scan may be helpful in diagnosing intrahepatic cholangiocarcinomas but usually cannot diagnose perihilar or CBD cholangiocarcinoma
13. Prophylactic antibiotics should be used when PSC patients undergo invasive cholangiography
14. Patients with PSC should be enrolled in a surveillance program for early detection of cholangiocarcinoma
15. Ursodeoxycholic acid does not change the natural history of PSC, thus, patients with PSC and ulcerative colitis do not need to take it