Endoscopic Retrograde Cholangiography Does Not Reliably Distinguish IgG4-Associated Cholangitis From Primary Sclerosing Cholangitis or Cholangiocarcinoma

Evangelos Kalaitzakis, Michael Levy, Terumi Kamisawa, Gavin J. Johnson, Todd H. Baron, Mark Topazian, Naoki Takahashi, Atsushi Kanno, Kazuichi Okazaki, Naoto Egawa, Kazushige Uchida, Kashif Sheikh, Zahir Amin, Tooru Shimosegawa, Neomal S. Sandanayake, Nicholas I. Church, Michael H. Chapman, Stephen P. Pereira, Suresh T Chari, George J M Webster

Research output: Contribution to journalArticle

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Abstract

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.

Original languageEnglish (US)
JournalClinical Gastroenterology and Hepatology
Volume9
Issue number9
DOIs
StatePublished - Sep 2011

Fingerprint

Sclerosing Cholangitis
Cholangitis
Cholangiocarcinoma
Cholangiography
Immunoglobulins
Immunoglobulin G
Diagnostic Errors
Japan
Physicians
Sensitivity and Specificity

Keywords

  • Autoimmune Pancreatitis
  • Endoscopic Retrograde Cholangiopancreatography
  • IgG4-Associated Cholangitis
  • Immunoglobulin G4

ASJC Scopus subject areas

  • Gastroenterology
  • Hepatology

Cite this

Endoscopic Retrograde Cholangiography Does Not Reliably Distinguish IgG4-Associated Cholangitis From Primary Sclerosing Cholangitis or Cholangiocarcinoma. / Kalaitzakis, Evangelos; Levy, Michael; Kamisawa, Terumi; Johnson, Gavin J.; Baron, Todd H.; Topazian, Mark; Takahashi, Naoki; Kanno, Atsushi; Okazaki, Kazuichi; Egawa, Naoto; Uchida, Kazushige; Sheikh, Kashif; Amin, Zahir; Shimosegawa, Tooru; Sandanayake, Neomal S.; Church, Nicholas I.; Chapman, Michael H.; Pereira, Stephen P.; Chari, Suresh T; Webster, George J M.

In: Clinical Gastroenterology and Hepatology, Vol. 9, No. 9, 09.2011.

Research output: Contribution to journalArticle

Kalaitzakis, E, Levy, M, Kamisawa, T, Johnson, GJ, Baron, TH, Topazian, M, Takahashi, N, Kanno, A, Okazaki, K, Egawa, N, Uchida, K, Sheikh, K, Amin, Z, Shimosegawa, T, Sandanayake, NS, Church, NI, Chapman, MH, Pereira, SP, Chari, ST & Webster, GJM 2011, 'Endoscopic Retrograde Cholangiography Does Not Reliably Distinguish IgG4-Associated Cholangitis From Primary Sclerosing Cholangitis or Cholangiocarcinoma', Clinical Gastroenterology and Hepatology, vol. 9, no. 9. https://doi.org/10.1016/j.cgh.2011.05.019
Kalaitzakis, Evangelos ; Levy, Michael ; Kamisawa, Terumi ; Johnson, Gavin J. ; Baron, Todd H. ; Topazian, Mark ; Takahashi, Naoki ; Kanno, Atsushi ; Okazaki, Kazuichi ; Egawa, Naoto ; Uchida, Kazushige ; Sheikh, Kashif ; Amin, Zahir ; Shimosegawa, Tooru ; Sandanayake, Neomal S. ; Church, Nicholas I. ; Chapman, Michael H. ; Pereira, Stephen P. ; Chari, Suresh T ; Webster, George J M. / Endoscopic Retrograde Cholangiography Does Not Reliably Distinguish IgG4-Associated Cholangitis From Primary Sclerosing Cholangitis or Cholangiocarcinoma. In: Clinical Gastroenterology and Hepatology. 2011 ; Vol. 9, No. 9.
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abstract = "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.",
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AU - Levy, Michael

AU - Kamisawa, Terumi

AU - Johnson, Gavin J.

AU - Baron, Todd H.

AU - Topazian, Mark

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 T

AU - Webster, George J M

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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.

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KW - Immunoglobulin G4

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