Endoscopic finding in patients with PSC: retraction of the main duodenal papilla into the duodenum wall

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Gastrointestinal Endoscopy

 Volume

65, Issue 3 , March 2007, Pages 532-536

An endoscopic

finding in patients with PSC: retraction of the main duodenal papilla into the

duodenum wall

Erkan Parlak MD, PhD, Bahattin Çiçek MD, Selçuk Diþibeyaz MD, Aydýn Þeref Köksal

MD & Burhan Þahin

MD, PhD

aCurrent

affiliations: Department of Gastroenterology, Türkiye Yüksek Ýhtisas

Hospital, Ankara,

Turkey

Background -

The diagnosis of primary sclerosing

cholangitis (PSC) is reached by typical cholangiographic findings and liver biopsy. The characteristic cholangiographic

abnormalities consist of multifocal strictures and

dilatations in the intrahepatic and/or extrahepatic bile ducts. Patients may develop cirrhosis and portal hypertension. Endoscopy may reveal esophageal/gastric varices and portal

hypertensive gastropathy.

Objective - To define a novel endoscopic

finding in patients with PSC.

Design - Case series.

Setting - Single tertiary referral center in Turkey.

Patients - Ten patients with PSC, 16 with liver

cirrhosis, and 10 with PSC-like cholangiogram.

Interventions - Inspection of papilla with duodenoscope and ERCP.

Main Outcome Measurements - Retraction of papilla into

the duodenum wall.

Results -

Ten patients with PSC (8 male, 2 female, mean age 38

y) underwent ERCP at our institution. Retraction of

papilla into the duodenum wall was observed in 7 patients (70%). The mean time elapsed between the retraction of the

papilla and onset of PSC was 5.1 years (range 2-7 y). In

patients with retraction of the papilla, both of the intrahepatic and

extrahepatic bile ducts were involved; however, only the intrahepatic bile

ducts were involved in patients with no retraction of papilla.

Of 7 patients with retraction of papilla, 5 had a history of sphincterotomy procedure 5.4 years previously (range 5-6 y). Two patients had native papilla. None

of the patients had end stage liver disease. Retraction

of papilla was observed in none of the 16 patients with cirrhosis of the liver

and in 10 with PSC-like cholangiogram.

Limitations - Only observational; absence of surgical

and/or pathologic evidence.

Conclusions -

Papilla may be embedded in the duodenum wall in some

patients with PSC. Extrahepatic involvement seems to

be necessary for the occurrence of this finding.

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