Diagnosis and treatment: ERCP in PSC

Abstract

Primary sclerosing cholangitis (PSC) is a chronic progressive cholestatic disease characterized by inflammatory destruction and fibrosis of both intra- and extra-hepatic bile ducts. Seen primarily in patients with underlying inflammatory bowel disease who have an increased risk of colorectal cancer, the most feared biliary complication of PSC is cholangiocarcinoma. Endoscopic cholangiopancreatography (ERCP) is a very useful diagnostic and therapeutic tool in the management of PSC and cholangiocarcinoma. In this chapter we review our current understanding of this complex biliary disorder, which includes the risk factors, pathogenesis, differential diagnosis, overlap syndromes, complications including cholangiocarcinoma, the role of ERCP in the diagnosis and management of complications related to PSC/cholangiocarcinoma, and the role of other noninvasive techniques such as magnetic resonance cholangiopancreatography (MRCP) and endoscopic ultrasound (EUS) in the diagnosis of PSC.