Endoscopic Retrograde Cholangiography Does Not Reliably Distinguish IgG4-Associated Cholangitis From Primary Sclerosing Cholangitis or Cholangiocarcinoma

• Published in: Clinical gastroenterology and hepatology Vol. 9; no. 9; pp. 800 - 803.e2
• Main Authors: Kalaitzakis, Evangelos, Levy, Michael, Kamisawa, Terumi, Johnson, Gavin J, Baron, Todd H, Topazian, Mark D, Takahashi, Naoki, Kanno, Atsushi, Okazaki, Kazuichi, Egawa, Naoto, Uchida, Kazushige, Sheikh, Kashif, Amin, Zahir, Shimosegawa, Tooru, Sandanayake, Neomal S, Church, Nicholas I, Chapman, Michael H, Pereira, Stephen P, Chari, Suresh, Webster, George J.M
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-09-2011
• Subjects: Autoimmune Pancreatitis; Cholangiocarcinoma - diagnosis; Cholangiopancreatography, Endoscopic Retrograde; Cholangitis - chemically induced; Cholangitis - diagnosis; Cholangitis - etiology; Clinical Medicine; Diagnosis, Differential; Diagnostic Errors - statistics & numerical data; Endoscopic Retrograde Cholangiopancreatography; Gastroenterology and Hepatology; Humans; IgG4-Associated Cholangitis; Immunoglobulin G - administration & dosage; Immunoglobulin G - adverse effects; Immunoglobulin G4; Japan; Klinisk medicin; Sensitivity and Specificity; United Kingdom; United States; Autoimmune Pancreatitis; PSC; IgG4-Associated Cholangitis; ERC; HISORt; Histology, Imaging, Serology, Other Organ involvement, Response to steroid therapy; IgG4; Immunoglobulin G4; endoscopic retrograde cholangiography; IAC; Endoscopic Retrograde Cholangiopancreatography; primary sclerosing cholangitis
• ISSN: 1542-3565; 1542-7714
• DOI: 10.1016/j.cgh.2011.05.019

Background & Aims Distinction of immunoglobulin G4–associated cholangitis (IAC) from primary sclerosing cholangitis (PSC) or cholangiocarcinoma is challenging. We aimed to assess the performance characteristics of endoscopic retrograde cholangiography (ERC) for the diagnosis of IAC. Methods Seventeen physicians from centers in the United States, Japan, and the United Kingdom, unaware of clinical data, reviewed 40 preselected ERCs of patients with IAC (n = 20), PSC (n = 10), and cholangiocarcinoma (n = 10). The performance characteristics of ERC for IAC diagnosis as well as the κ statistic for intraobserver and interobserver agreement were calculated. Results The overall specificity, sensitivity, and interobserver agreement for the diagnosis of IAC were 88%, 45%, and 0.18, respectively. Reviewer origin, specialty, or years of experience had no statistically significant effect on reporting success. The overall intraobserver agreement was fair (0.74). The operating characteristics of different ERC features for the diagnosis of IAC were poor. Conclusions Despite high specificity of ERC for diagnosing IAC, sensitivity is poor, suggesting that many patients with IAC may be misdiagnosed with PSC or cholangiocarcinoma. Additional diagnostic strategies are likely to be vital in distinguishing these diseases.