Re: ERCPS more harm than good?

[Guest guest]

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the specialist she sees diagnosed her PSC by blood tests and an

MRCP is asymptomatic, the specialist refuses to do an ERCP to absolutely confirm

the PSC diagnoses as he feels that ERCPS speed up the course of the disease.

Any comments?

[Guest guest]

Hi ;

I think it depends a lot on the expertise of the endoscopist doing the

ERCPs. The expert German group (Adolph Stiehl and colleagues) believes

that ERCPs, to open dominant bile duct strictures, can help alleviate

symptoms and prolong survival free of transplantation:

Curr Treat Options Gastroenterol. 2007 Mar;10(2):111-9.

Treatment of primary sclerosing cholangitis.

Rost D, Kulaksiz H, Stiehl A.

Adolf Stiehl, MD Department of Medicine, University of Heidelberg,

Medizinische Universitatsklinik, Im Neuenheimer Feld 410, 69120

Heidelberg, Germany. adolf_stiehl@....

Aims of treatment for primary sclerosing cholangitis are as follows:

prevention of progression of hepatobiliary disease, reduction of

symptoms and consequences of cholestasis (pruritus, osteoporosis), and

prevention of complications (colorectal cancer, hepatobiliary cancer).

Ursodeoxycholic acid (UDCA) improves biliary secretion and laboratory

parameters of cholestasis, but its effects on liver histology and

survival are not clear. It reduces the incidence of dysplasias and

carcinomas of the colon in patients with colitis and possibly has a

beneficial effect on the incidence of bile duct carcinomas. At present,

UDCA represents the most promising therapeutic option.

Immunosuppressive treatment has not been proven to be effective; it

appears to be indicated in the overlap syndrome with autoimmune

hepatitis but may be harmful in bacterial cholangitis. Bacterial

cholangitis is common in patients with dominant stenoses and requires

antibiotic treatment. Endoscopic treatment of dominant stenoses

improves cholestasis and prolongs survival in comparison to predicted

survival. Pruritus represents a problem in some patients, and

cholestyramine represents the first-line treatment. If ineffective,

opioid antagonists, rifampin, or ondansetron may be tried. For

treatment of osteoporosis and osteopenia, calcium and vitamin D

supplementation are recommended, and in selected cases, bisphosphonates

may be indicated. In patients with severe cholestasis and coagulation

defects, parenteral supplementation of vitamin K may be indicated.

During treatment, all patients should be regularly screened for colonic

and bile duct carcinomas. Patients with cirrhosis of the liver and its

complications are treated accordingly, and in end-stage disease, liver

transplantation is indicated. PMID: 17391626.

But for an asymptomatic patient who has already had an MRCP I can't see

any obvious benefit of doing an ERCP .... this probably would not

change the treatment, and might run the risk of pancreatitis and/or

cholangitis.

Best regards,

Dave

(father of (21); PSC 07/03; UC 08/83)

level..LOL.. so what is considered professional level ?

> I am in contact with another New Zealander with PSC, the specialsit

she sees diagnosed her PSC by blood tests and an MRCP. At the moment

she is asymptomatic, the specialsit refuses to do an ERCP to

absolutely confirm the PSC diagnoses as he feels that ERCPS speed up

the course of the disease. Any comments?