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

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

doi:10.1055/s-0043-107029

Cited by 255Liver Diseases and ImmunityGallbladder and Bile Duct DisordersPediatric Hepatobiliary Diseases and Treatments

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

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Aabakken, Lars, Karlsen, Tom, Albert, Jörg, Arvanitakis, Marianna, Chazouilleres, Olivier, Dumonceau, Jean-Marc, Färkkilä, Martti, Fickert, Peter +12 more·2017·Endoscopy

DOI 10.1055/s-0043-107029

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Abstract

MAIN RECOMMENDATIONS: 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.

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MRI is superior to ultrasound for early detection of CCA.
“MRI has been shown to be superior to ultrasound for early detection of CCA.116,294”
From EASL Clinical Practice Guidelines on sclerosing cholangitis (2022) · cites this paper as [294]

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Authors: Aabakken, L., Karlsen, T., Albert, J., Arvanitakis, M., Chazouilleres, O., Dumonceau, J.-M., Färkkilä, M., Fickert, P., Hirschfield, G., Laghi, A., Marzioni, M., Fernandez, M., Pereira, S., Pohl, J., Poley, J.-W., Ponsioen, C., Schramm, C., Swahn, F., Tringali, A., & Hassan, C.
Affiliations: University of Oslo (NO)
Oslo University Hospital (NO)
Robert Bosch Hospital (DE)
Université Libre de Bruxelles (BE)
Service d’Hépatologie, Hôpital Saint-Antoine, Assistance Publique – Hôpitaux de Paris, Centre de référence des maladies inflammatoires du foie et des voies biliaires, Filière Maladies Rares du Foie de l’Adulte et de l’Enfant (FILFOIE), UPMC UNIV Paris 06, France
Gastroenterología Diagnóstica Terapeútica (AR)
Helsinki University Hospital (FI)
Medical University of Graz (AT)
National Institute for Health and Care Research (GB)
Sapienza University of Rome (IT)
Marche Polytechnic University (IT)
Department of Gastroenterology, Hepatopancreatology and Digestive Oncology, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium
The Royal Free Hospital (GB)
Klinikum im Friedrichshain (DE)
Erasmus MC (NL)
Amsterdam UMC Location University of Amsterdam (NL)
University Medical Center Hamburg-Eppendorf (DE)
Karolinska University Hospital (SE)
Digestive Endoscopy Unit, Catholic University, Rome, Italy
Digestive Endoscopy Unit, Nuovo Regina Margherita Hospital, Rome, Italy
ORCID: Aabakken, Lars
Karlsen, Tom
Albert, Jörg
Arvanitakis, Marianna
Dumonceau, Jean-Marc
Färkkilä, Martti
Fickert, Peter
Hirschfield, Gideon
Laghi, Andrea
Marzioni, Marco
Pereira, Stephen
Poley, Jan-Werner
Ponsioen, Cyriel
Schramm, Christoph
Tringali, Andrea
Hassan, Cesare
Venue: Endoscopy
Publisher: Georg Thieme Verlag KG
Published: 2017-04-18
Volume: 49
Issue: 06
Pages: 588-608
ISSN: 0013-726X (ISSN-L)
1438-8812
DOI: 10.1055/s-0043-107029
OpenAlex: W2607081164
Cited by: 255
References: 140
Citations by year: 2026: 12 · 2025: 17 · 2024: 26 · 2023: 25 · 2022: 28 · 2021: 36 · 2020: 35 · 2019: 41 · 2018: 29 · 2017: 5
FWCI: 18.59
Type: journal article
Language: en
Open access: bronze
doi.org
Locations: Endoscopy (publishedVersion)
PubMed (publishedVersion)
Zurich Open Repository and Archive (University of Zurich) (acceptedVersion, other-oa)
Pure Amsterdam UMC (submittedVersion, other-oa)
University of Birmingham Research Portal (University of Birmingham) (submittedVersion)
Data Archiving and Networked Services (DANS) (submittedVersion)
RePub (Erasmus University Rotterdam) (submittedVersion, other-oa)
Dépôt institutionnel de l'Université libre de Bruxelles (Université Libre de Bruxelles) (submittedVersion)
UCL Discovery (University College London) (submittedVersion)
IRIS Research product catalog (Sapienza University of Rome) (submittedVersion)
Zurich Open Repository and Archive (University of Zurich) (submittedVersion, other-oa)
Zurich Open Repository and Archive (University of Zurich)
Topics: Health Sciences › Medicine › Hepatology › Liver Diseases and Immunity
Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Gallbladder and Bile Duct Disorders
Health Sciences › Medicine › Surgery › Pediatric Hepatobiliary Diseases and Treatments
Keywords: primary sclerosing cholangitis, endoscopic diagnosis, magnetic resonance cholangiography, endoscopic retrograde cholangiopancreatography, biliary strictures, brush cytology, sphincterotomy, antibiotic prophylaxis, cholangiocarcinoma, CA19-9, cholestasis
MeSH terms: Bile Duct Neoplasms, Biopsy, Cholangiography, Cholangiopancreatography, Endoscopic Retrograde, Humans, Magnetic Resonance Imaging, Cholangitis, Sclerosing, Sphincterotomy, Endoscopic, Cholangiocarcinoma

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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

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