| セッション情報 | International Session3(消化器内視鏡学会・消化器病学会合同)IgG4-related disease and endoscopy |
|---|---|
| タイトル | 内IS3-5：Endoscopic biliary intraductal ultrasonography and biopsy from bile duct and duodenal papilla in the diagnosis of IgG4-related sclerosing cholangitis |
| 演者 | T. Nakazawa（Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences） |
| 共同演者 | I. Naitoh（Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences）, H. Ohara（Department of Community-based Medical Education, Nagoya City University Graduate School of Medical Sciences） |
| 抄録 | <Aims>It is sometimes difficult to differentiate IgG4-related sclerosing cholangitis(IgG4-SC) from cholangiocarcinoma(CC) or pancreatic cancer(PC) on the cholangiogram. We aimed to clarify the findings of biliary intraductal ultrasonography (IDUS) and biopsy from bile duct and duodenal papilla in the diagnosis of IgG4-SC. <Methods> 36 patients with IgG4-SC from 2004 and to 2012, forty-six patients with CC and 35 patients with PC (controls) were enrolled in the study. <Results> The bile duct wall thickness of IDUS in IgG4-SC in regions of non-stricture on the cholangiogram was significantly greater than that in control group (1.33mm vs 0.53mm; p<0.001). Wall thickness exceeding 0.8 mm in regions of non-stricture on the cholangiogram was highly suggestive of IgG4-SC (sensitivity 93.3%, specificity 87.5%, accuracy 89.5%). The number of IgG4-positive plasma cells per high power field (HPF) was significantly higher in duodenal papilla biopsy than bile duct biopsy in IgG4-SC (14.3 cells vs 7.2 cells ; p=0.001).The frequency of >10 IgG4+ plasma cells / HPF was significantly higher in duodenal papilla biopsy than bile duct biopsy (9/17,53% vs 6/27,22%, p=0.036). Malignacy was observed in 55% (43/78) of bile duct biopsy in control group (CC,61%, PC,47%). <Conclusions> The IDUS and Duodenal papilla biopsy are useful in the differentiation of IgG4-SC from PC and CC. |
| 索引用語 | IgG4-related sclerosing cholangitis, IgG4-SC |