TY - JOUR
T1 - Endoscopic Retrograde Cholangiography Does Not Reliably Distinguish IgG4-Associated Cholangitis From Primary Sclerosing Cholangitis or Cholangiocarcinoma
AU - Kalaitzakis, Evangelos
AU - Levy, Michael
AU - Kamisawa, Terumi
AU - Johnson, Gavin J.
AU - Baron, Todd H.
AU - Topazian, Mark D.
AU - Takahashi, Naoki
AU - Kanno, Atsushi
AU - Okazaki, Kazuichi
AU - Egawa, Naoto
AU - Uchida, Kazushige
AU - Sheikh, Kashif
AU - Amin, Zahir
AU - Shimosegawa, Tooru
AU - Sandanayake, Neomal S.
AU - Church, Nicholas I.
AU - Chapman, Michael H.
AU - Pereira, Stephen P.
AU - Chari, Suresh
AU - Webster, George J.M.
N1 - Funding Information:
This work was undertaken at UCLH/UCL, who receives a proportion of funding from the Department of Health's NIHR Biomedical Research Centres funding scheme.
PY - 2011/9
Y1 - 2011/9
N2 - 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.
AB - 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.
KW - Autoimmune Pancreatitis
KW - Endoscopic Retrograde Cholangiopancreatography
KW - IgG4-Associated Cholangitis
KW - Immunoglobulin G4
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U2 - 10.1016/j.cgh.2011.05.019
DO - 10.1016/j.cgh.2011.05.019
M3 - Article
C2 - 21699807
AN - SCOPUS:80052031805
SN - 1542-3565
VL - 9
SP - 800-803.e2
JO - Clinical Gastroenterology and Hepatology
JF - Clinical Gastroenterology and Hepatology
IS - 9
ER -