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

Lars Aabakken; Tom H Karlsen; Jörg Albert; Marianna Arvanitakis; Olivier Chazouilleres; Jean-Marc Dumonceau; Martti Färkkilä; Peter Fickert; Gideon M Hirschfield; Andrea Laghi; Marco Marzioni; Michael Fernandez; Stephen P Pereira; Jürgen Pohl; Jan-Werner Poley; Cyriel Y Ponsioen; Christoph Schramm; Fredrik Swahn; Andrea Tringali; Cesare Hassan

doi:10.1055/s-0043-107029

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

Lars Aabakken, Tom H Karlsen, Jörg Albert, Marianna Arvanitakis, Olivier Chazouilleres, Jean-Marc Dumonceau, Martti Färkkilä, Peter Fickert, Gideon M Hirschfield, Andrea Laghi, Marco Marzioni, Michael Fernandez, Stephen P Pereira, Jürgen Pohl, Jan-Werner Poley, Cyriel Y Ponsioen, Christoph Schramm, Fredrik Swahn, Andrea Tringali, Cesare Hassan

Immunology and Immunotherapy

Research output: Contribution to journal › Article › peer-review

67 Citations (Scopus)

Abstract

1 ESGE/EASL recommend that, as the primary diagnostic modality for PSC, magnetic resonance cholangiography (MRC) should be preferred over endoscopic retrograde cholangiopancreatography (ERCP).

Moderate quality evidence, strong recommendation.

2 ESGE/EASL suggest that ERCP can be considered if MRC plus liver biopsy is equivocal or contraindicated in patients with persisting clinical suspicion of PSC. The risks of ERCP have to be weighed against the potential benefit with regard to surveillance and treatment recommendations.

Low quality evidence, weak recommendation.

6 ESGE/EASL suggest that, in patients with an established diagnosis of PSC, MRC should be considered before therapeutic ERCP.

Weak recommendation, low quality evidence.

7 ESGE/EASL suggest performing endoscopic treatment with concomitant ductal sampling (brush cytology, endobiliary biopsies) of suspected significant strictures identified at MRC in PSC patients who present with symptoms likely to improve following endoscopic treatment.

Strong recommendation, low quality evidence.

9 ESGE/EASL recommend weighing the anticipated benefits of biliary papillotomy/sphincterotomy against its risks on a case-by-case basis.

Strong recommendation, moderate quality evidence.

Biliary papillotomy/sphincterotomy should be considered especially after difficult cannulation.

Strong recommendation, low quality evidence.

16 ESGE/EASL suggest routine administration of prophylactic antibiotics before ERCP in patients with PSC.

Strong recommendation, low quality evidence.

17 EASL/ESGE recommend that cholangiocarcinoma (CCA) should be suspected in any patient with worsening cholestasis, weight loss, raised serum CA19-9, and/or new or progressive dominant stricture, particularly with an associated enhancing mass lesion.

Strong recommendation, moderate quality evidence.

19 ESGE/EASL recommend ductal sampling (brush cytology, endobiliary biopsies) as part of the initial investigation for the diagnosis and staging of suspected CCA in patients with PSC.

Strong recommendation, high quality evidence.

Original language	English
Pages (from-to)	588-608
Number of pages	21
Journal	Endoscopy
Volume	49
Issue number	6
Early online date	18 Apr 2017
DOIs	https://doi.org/10.1055/s-0043-107029
Publication status	Published - Jun 2017

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Aabakken, L., Karlsen, T. H., Albert, J., Arvanitakis, M., Chazouilleres, O., Dumonceau, J-M., Färkkilä, M., Fickert, P., Hirschfield, G. M., Laghi, A., Marzioni, M., Fernandez, M., Pereira, S. P., Pohl, J., Poley, J-W., Ponsioen, C. Y., Schramm, C., Swahn, F., Tringali, A., & Hassan, C. (2017). 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. Endoscopy, 49(6), 588-608. Advance online publication. https://doi.org/10.1055/s-0043-107029

@article{95f2dd0538df4b4098faeb293a06abab,

title = "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",

abstract = "1 ESGE/EASL recommend that, as the primary diagnostic modality for PSC, magnetic resonance cholangiography (MRC) should be preferred over endoscopic retrograde cholangiopancreatography (ERCP).Moderate quality evidence, strong recommendation.2 ESGE/EASL suggest that ERCP can be considered if MRC plus liver biopsy is equivocal or contraindicated in patients with persisting clinical suspicion of PSC. The risks of ERCP have to be weighed against the potential benefit with regard to surveillance and treatment recommendations.Low quality evidence, weak recommendation.6 ESGE/EASL suggest that, in patients with an established diagnosis of PSC, MRC should be considered before therapeutic ERCP.Weak recommendation, low quality evidence.7 ESGE/EASL suggest performing endoscopic treatment with concomitant ductal sampling (brush cytology, endobiliary biopsies) of suspected significant strictures identified at MRC in PSC patients who present with symptoms likely to improve following endoscopic treatment.Strong recommendation, low quality evidence.9 ESGE/EASL recommend weighing the anticipated benefits of biliary papillotomy/sphincterotomy against its risks on a case-by-case basis.Strong recommendation, moderate quality evidence.Biliary papillotomy/sphincterotomy should be considered especially after difficult cannulation.Strong recommendation, low quality evidence.16 ESGE/EASL suggest routine administration of prophylactic antibiotics before ERCP in patients with PSC.Strong recommendation, low quality evidence.17 EASL/ESGE recommend that cholangiocarcinoma (CCA) should be suspected in any patient with worsening cholestasis, weight loss, raised serum CA19-9, and/or new or progressive dominant stricture, particularly with an associated enhancing mass lesion.Strong recommendation, moderate quality evidence.19 ESGE/EASL recommend ductal sampling (brush cytology, endobiliary biopsies) as part of the initial investigation for the diagnosis and staging of suspected CCA in patients with PSC.Strong recommendation, high quality evidence.",

author = "Lars Aabakken and Karlsen, {Tom H} and J{\"o}rg Albert and Marianna Arvanitakis and Olivier Chazouilleres and Jean-Marc Dumonceau and Martti F{\"a}rkkil{\"a} and Peter Fickert and Hirschfield, {Gideon M} and Andrea Laghi and Marco Marzioni and Michael Fernandez and Pereira, {Stephen P} and J{\"u}rgen Pohl and Jan-Werner Poley and Ponsioen, {Cyriel Y} and Christoph Schramm and Fredrik Swahn and Andrea Tringali and Cesare Hassan",

note = "{\textcopyright} Georg Thieme Verlag KG Stuttgart · New York.",

year = "2017",

month = jun,

doi = "10.1055/s-0043-107029",

language = "English",

volume = "49",

pages = "588--608",

journal = "Endoscopy",

issn = "0013-726X",

publisher = "Georg Thieme Verlag",

number = "6",

}

Aabakken, L, Karlsen, TH, Albert, J, Arvanitakis, M, Chazouilleres, O, Dumonceau, J-M, Färkkilä, M, Fickert, P, Hirschfield, GM, Laghi, A, Marzioni, M, Fernandez, M, Pereira, SP, Pohl, J, Poley, J-W, Ponsioen, CY, Schramm, C, Swahn, F, Tringali, A & Hassan, C 2017, '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', Endoscopy, vol. 49, no. 6, pp. 588-608. https://doi.org/10.1055/s-0043-107029

TY - JOUR

T1 - Role of endoscopy in primary sclerosing cholangitis:

T2 - European Society of Gastrointestinal Endoscopy (ESGE) and European Association for the Study of the Liver (EASL) Clinical Guideline

AU - Aabakken, Lars

AU - Karlsen, Tom H

AU - Albert, Jörg

AU - Arvanitakis, Marianna

AU - Chazouilleres, Olivier

AU - Dumonceau, Jean-Marc

AU - Färkkilä, Martti

AU - Fickert, Peter

AU - Hirschfield, Gideon M

AU - Laghi, Andrea

AU - Marzioni, Marco

AU - Fernandez, Michael

AU - Pereira, Stephen P

AU - Pohl, Jürgen

AU - Poley, Jan-Werner

AU - Ponsioen, Cyriel Y

AU - Schramm, Christoph

AU - Swahn, Fredrik

AU - Tringali, Andrea

AU - Hassan, Cesare

PY - 2017/6

Y1 - 2017/6

N2 - 1 ESGE/EASL recommend that, as the primary diagnostic modality for PSC, magnetic resonance cholangiography (MRC) should be preferred over endoscopic retrograde cholangiopancreatography (ERCP).Moderate quality evidence, strong recommendation.2 ESGE/EASL suggest that ERCP can be considered if MRC plus liver biopsy is equivocal or contraindicated in patients with persisting clinical suspicion of PSC. The risks of ERCP have to be weighed against the potential benefit with regard to surveillance and treatment recommendations.Low quality evidence, weak recommendation.6 ESGE/EASL suggest that, in patients with an established diagnosis of PSC, MRC should be considered before therapeutic ERCP.Weak recommendation, low quality evidence.7 ESGE/EASL suggest performing endoscopic treatment with concomitant ductal sampling (brush cytology, endobiliary biopsies) of suspected significant strictures identified at MRC in PSC patients who present with symptoms likely to improve following endoscopic treatment.Strong recommendation, low quality evidence.9 ESGE/EASL recommend weighing the anticipated benefits of biliary papillotomy/sphincterotomy against its risks on a case-by-case basis.Strong recommendation, moderate quality evidence.Biliary papillotomy/sphincterotomy should be considered especially after difficult cannulation.Strong recommendation, low quality evidence.16 ESGE/EASL suggest routine administration of prophylactic antibiotics before ERCP in patients with PSC.Strong recommendation, low quality evidence.17 EASL/ESGE recommend that cholangiocarcinoma (CCA) should be suspected in any patient with worsening cholestasis, weight loss, raised serum CA19-9, and/or new or progressive dominant stricture, particularly with an associated enhancing mass lesion.Strong recommendation, moderate quality evidence.19 ESGE/EASL recommend ductal sampling (brush cytology, endobiliary biopsies) as part of the initial investigation for the diagnosis and staging of suspected CCA in patients with PSC.Strong recommendation, high quality evidence.

AB - 1 ESGE/EASL recommend that, as the primary diagnostic modality for PSC, magnetic resonance cholangiography (MRC) should be preferred over endoscopic retrograde cholangiopancreatography (ERCP).Moderate quality evidence, strong recommendation.2 ESGE/EASL suggest that ERCP can be considered if MRC plus liver biopsy is equivocal or contraindicated in patients with persisting clinical suspicion of PSC. The risks of ERCP have to be weighed against the potential benefit with regard to surveillance and treatment recommendations.Low quality evidence, weak recommendation.6 ESGE/EASL suggest that, in patients with an established diagnosis of PSC, MRC should be considered before therapeutic ERCP.Weak recommendation, low quality evidence.7 ESGE/EASL suggest performing endoscopic treatment with concomitant ductal sampling (brush cytology, endobiliary biopsies) of suspected significant strictures identified at MRC in PSC patients who present with symptoms likely to improve following endoscopic treatment.Strong recommendation, low quality evidence.9 ESGE/EASL recommend weighing the anticipated benefits of biliary papillotomy/sphincterotomy against its risks on a case-by-case basis.Strong recommendation, moderate quality evidence.Biliary papillotomy/sphincterotomy should be considered especially after difficult cannulation.Strong recommendation, low quality evidence.16 ESGE/EASL suggest routine administration of prophylactic antibiotics before ERCP in patients with PSC.Strong recommendation, low quality evidence.17 EASL/ESGE recommend that cholangiocarcinoma (CCA) should be suspected in any patient with worsening cholestasis, weight loss, raised serum CA19-9, and/or new or progressive dominant stricture, particularly with an associated enhancing mass lesion.Strong recommendation, moderate quality evidence.19 ESGE/EASL recommend ductal sampling (brush cytology, endobiliary biopsies) as part of the initial investigation for the diagnosis and staging of suspected CCA in patients with PSC.Strong recommendation, high quality evidence.

U2 - 10.1055/s-0043-107029

DO - 10.1055/s-0043-107029

M3 - Article

C2 - 28420030

SN - 0013-726X

VL - 49

SP - 588

EP - 608

JO - Endoscopy

JF - Endoscopy

IS - 6

ER -

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

Abstract

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