Endoscopic retrograde cholangiopancreatography and intraductal ultrasonography in the diagnosis of autoimmune pancreatitis and IgG4-related sclerosing cholangitis
Endoscopic retrograde cholangiopancreatography and intraductal ultrasonography in the diagnosis of autoimmune pancreatitis and IgG4-related sclerosing cholangitis
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内镜逆行胰胆管造影和导管内超声诊断自身免疫性胰腺炎和IgG4相关硬化性胆管炎
DOI：
10.1007/s10396-021-01114-1
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发表时间：
2021
期刊：
影响因子：
1.8
通讯作者：
Takahiro Nakazawa
中科院分区：
文献类型：
--
作者：
Itaru Naitoh;Takahiro Nakazawa
内镜逆行胆管造影用于评估自身免疫性胰腺炎（AIP）主胰管狭窄和igg4相关性硬化性胆管炎（IgG4-SC）胆道狭窄。导管内超声检查可以详细显示IgG4-SC胆管壁增厚。胰腺癌、胆管癌和原发性硬化性胆管炎是AIP和IgG4-SC的重要模拟条件。无明显上游扩张的弥漫性或节段性狭窄是AIP的典型胰脏影像学表现。相比之下，一个单一的，短的狭窄与明显的上游扩张是胰腺癌的典型发现。IgG4-SC胆道造影根据胆道狭窄的位置分为四种类型，这种胆道造影分类有助于IgG4-SC的鉴别诊断。内镜逆行胆管造影可用于区分IgG4-SC和原发性硬化性胆管炎。IgG4-SC的特征性表现为节段性/长型胰腺内狭窄，而原发性硬化性胆管炎的特征性表现为带状狭窄、串珠状或剪枝状外观和憩室样流出。胆道狭窄部位超声表现为圆形对称壁增厚、内外缘光滑、内回声均匀，对诊断IgG4-SC有重要价值。非狭窄部位的胆管壁增厚也是IgG4-SC的典型导管内超声表现，可用于胆管癌的鉴别诊断。内镜逆行胆管造影时，经乳头胆管和十二指肠乳头活检也有助于诊断IgG4-SC。
Endoscopic retrograde cholangiopancreatography is used to evaluate the narrowing of the main pancreatic duct in autoimmune pancreatitis (AIP) and biliary stricture in IgG4-related sclerosing cholangitis (IgG4-SC). Intraductal ultrasonography enables detailed visualization of the thickening of the bile duct wall in IgG4-SC. Pancreatic cancer, cholangiocarcinoma, and primary sclerosing cholangitis are important mimicking conditions of AIP and IgG4-SC. Diffuse or segmental stricture without marked upstream dilatation is a typical pancreatographic finding in AIP. By contrast, a single, short stricture with marked upstream dilatation is a typical finding in pancreatic cancer. The cholangiogram of IgG4-SC is classified into four types based on biliary stricture location, and this cholangiogram classification is useful for the differential diagnosis of IgG4-SC. Endoscopic retrograde cholangiography can be used to distinguish between IgG4-SC and primary sclerosing cholangitis. A segmental/long and intrapancreatic stricture is a characteristic finding of IgG4-SC, whereas band-like strictures, a beaded or pruned-tree appearance, and diverticulum-like outpouching are characteristic of primary sclerosing cholangitis. The characteristic intraductal ultrasonographic findings of circular–symmetrical wall thickening, smooth outer and inner margins, and homogeneous internal echo at the biliary stricture site are useful for diagnosis of IgG4-SC. Thickening of the bile duct wall at non-stricture sites is also a typical intraductal ultrasonographic finding of IgG4-SC and can be used for differential diagnosis from cholangiocarcinoma. Transpapillary bile duct and duodenal papilla biopsy during endoscopic retrograde cholangiopancreatography are also useful in the diagnosis of IgG4-SC.