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Practice Guideline
, 49 (6), 588-608

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

Practice Guideline

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 et al. Endoscopy.


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.

Conflict of interest statement

Competing interests: J. Albert has received (from 2015 to 2016) speaker’s honoraria from Fujifilm, the Falk Foundation, Covidien/Medtronic, and Olympus Europe, an honorarium from Covidien/Medtronic for advisory services, and research support from Olympus Europe. P. Fickert has served on advisory boards for Dr. Falk Pharma and Intercept; his department has received unrestricted research grants from the Falk Foundation (since 2010) and Gilead (since 2012); he is listed as co-inventor in two patents filed by the Medical University of Graz for the use of norUDCA in the treatment of liver diseases and arteriosclerosis (publication numbers WO2006119803 and WO20099013334). A. Laghi has received a speaker fee from GE Healthcare (October 2016). J.-W. Poley receives consultancy, travel, and speaker fees from Cook Endoscopy; his department receives financial support for consultancy, travel, and speaking from Boston Scientific; he receives travel and consultancy fees from Pentax. C. Ponsioen’s department is receiving research support from Olympus and Fujifilm. C. Schramm has served on an advisory board for Intercept Pharmaceuticals (2016), and has given lectures sponsored by Intercept and the Falk Foundation. F. Swahn has served on a scientific advisory board for Rhenman & Partners, and has given lectures sponsored by Cook Medical Sweden and Boston Scientific Nordic. L. Aabakken, M. Arvanitakis, O. Chazouilleres, J.-M. Dumonceau, M. Färrkkilä, C. Hassan, G. Hirschfield, T. Karlsen, M. Marzioni, M. Fernandez, S. Pereira, J. Pohl, and A. Tringali have no competing interests.

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