Obstructive jaundice in autoimmune pancreatitis can be safely treated with corticosteroids alone without biliary stenting

Yan Bi, Phil A. Hart, Ryan Law, Jonathan E. Clain, Michael B. Farnell, Ferga C. Gleeson, Michael L. Kendrick, Mike J. Levy, Randall K. Pearson, Bret Thomas Petersen, Lisa D. Pisney, Thomas Christopher Smyrk, Naoki Takahashi, Mark Topazian, Santhi Swaroop Vege, Suresh T Chari

Research output: Contribution to journalArticle

17 Citations (Scopus)

Abstract

Objective: Autoimmune pancreatitis (AIP) responds dramatically to corticosteroids treatment. We reviewed our experience to determine the safety and effectiveness of treating obstructive jaundice in definitive AIP with corticosteroids alone without biliary stenting. Methods: From our AIP database, we retrospectively identified type 1 AIP subjects whose jaundice was treated with corticosteroids alone without biliary stenting. Their medical records were reviewed and clinical data were evaluated to determine the outcomes. Results: Fifteen AIP subjects (87% male, mean age 68.4 years) were treated with corticosteroids at initial presentation (n = 8), first (n = 5) or subsequent (n = 2) relapse. Mean values (upper limit of normal, ULN) of liver tests prior to corticosteroids were aspartate aminotransferase (AST) 203.5u/l (4 × ULN), alanine aminotransferase (ALT) 325.8u/l (6 × ULN), alkaline phosphatase (ALP) 567.4u/l (5 × ULN), and total bilirubin (TB) 5.9 mg/dl (5.9 × ULN). At first follow-up (mean 4 days) the decrease was 54.9% for AST, 51.6% for ALT, 33% for ALP and 47.2% for TB (all p <0.05). After 15-45 days, all patients had normal AST, 3/15 had ALT > 1.5 × ULN, 1/15 had ALP > 1.5 × ULN, 1/15 had TB > 1.5 × ULN. No patient required biliary stent placement, or developed cholangitis or other infectious complications during steroid treatment. Conclusion: Under the supervision of an experienced pancreatologist and with close monitoring of patients, obstructive jaundice secondary to definitive AIP can be safely and effectively managed with corticosteroids alone, without the need for biliary stenting.

Original languageEnglish (US)
JournalPancreatology
DOIs
StateAccepted/In press - 2016

Fingerprint

Obstructive Jaundice
Pancreatitis
Adrenal Cortex Hormones
Bilirubin
Alkaline Phosphatase
Aspartate Aminotransferases
Alanine Transaminase
Cholangitis
Physiologic Monitoring
Jaundice
Stents
Medical Records
Steroids
Databases
Safety
Recurrence
Liver
Therapeutics

Keywords

  • Autoimmune pancreatitis
  • Cholangitis
  • Chronic pancreatitis
  • ERCP (Endoscopic retrograde cholangiopancreatography)
  • Obstructive jaundice
  • Prednisone

ASJC Scopus subject areas

  • Endocrinology
  • Endocrinology, Diabetes and Metabolism
  • Hepatology

Cite this

Bi, Y., Hart, P. A., Law, R., Clain, J. E., Farnell, M. B., Gleeson, F. C., ... Chari, S. T. (Accepted/In press). Obstructive jaundice in autoimmune pancreatitis can be safely treated with corticosteroids alone without biliary stenting. Pancreatology. https://doi.org/10.1016/j.pan.2016.03.017

Obstructive jaundice in autoimmune pancreatitis can be safely treated with corticosteroids alone without biliary stenting. / Bi, Yan; Hart, Phil A.; Law, Ryan; Clain, Jonathan E.; Farnell, Michael B.; Gleeson, Ferga C.; Kendrick, Michael L.; Levy, Mike J.; Pearson, Randall K.; Petersen, Bret Thomas; Pisney, Lisa D.; Smyrk, Thomas Christopher; Takahashi, Naoki; Topazian, Mark; Vege, Santhi Swaroop; Chari, Suresh T.

In: Pancreatology, 2016.

Research output: Contribution to journalArticle

Bi, Y, Hart, PA, Law, R, Clain, JE, Farnell, MB, Gleeson, FC, Kendrick, ML, Levy, MJ, Pearson, RK, Petersen, BT, Pisney, LD, Smyrk, TC, Takahashi, N, Topazian, M, Vege, SS & Chari, ST 2016, 'Obstructive jaundice in autoimmune pancreatitis can be safely treated with corticosteroids alone without biliary stenting', Pancreatology. https://doi.org/10.1016/j.pan.2016.03.017
Bi, Yan ; Hart, Phil A. ; Law, Ryan ; Clain, Jonathan E. ; Farnell, Michael B. ; Gleeson, Ferga C. ; Kendrick, Michael L. ; Levy, Mike J. ; Pearson, Randall K. ; Petersen, Bret Thomas ; Pisney, Lisa D. ; Smyrk, Thomas Christopher ; Takahashi, Naoki ; Topazian, Mark ; Vege, Santhi Swaroop ; Chari, Suresh T. / Obstructive jaundice in autoimmune pancreatitis can be safely treated with corticosteroids alone without biliary stenting. In: Pancreatology. 2016.
@article{16d6c49df6a340908472012aee76dc5a,
title = "Obstructive jaundice in autoimmune pancreatitis can be safely treated with corticosteroids alone without biliary stenting",
abstract = "Objective: Autoimmune pancreatitis (AIP) responds dramatically to corticosteroids treatment. We reviewed our experience to determine the safety and effectiveness of treating obstructive jaundice in definitive AIP with corticosteroids alone without biliary stenting. Methods: From our AIP database, we retrospectively identified type 1 AIP subjects whose jaundice was treated with corticosteroids alone without biliary stenting. Their medical records were reviewed and clinical data were evaluated to determine the outcomes. Results: Fifteen AIP subjects (87{\%} male, mean age 68.4 years) were treated with corticosteroids at initial presentation (n = 8), first (n = 5) or subsequent (n = 2) relapse. Mean values (upper limit of normal, ULN) of liver tests prior to corticosteroids were aspartate aminotransferase (AST) 203.5u/l (4 × ULN), alanine aminotransferase (ALT) 325.8u/l (6 × ULN), alkaline phosphatase (ALP) 567.4u/l (5 × ULN), and total bilirubin (TB) 5.9 mg/dl (5.9 × ULN). At first follow-up (mean 4 days) the decrease was 54.9{\%} for AST, 51.6{\%} for ALT, 33{\%} for ALP and 47.2{\%} for TB (all p <0.05). After 15-45 days, all patients had normal AST, 3/15 had ALT > 1.5 × ULN, 1/15 had ALP > 1.5 × ULN, 1/15 had TB > 1.5 × ULN. No patient required biliary stent placement, or developed cholangitis or other infectious complications during steroid treatment. Conclusion: Under the supervision of an experienced pancreatologist and with close monitoring of patients, obstructive jaundice secondary to definitive AIP can be safely and effectively managed with corticosteroids alone, without the need for biliary stenting.",
keywords = "Autoimmune pancreatitis, Cholangitis, Chronic pancreatitis, ERCP (Endoscopic retrograde cholangiopancreatography), Obstructive jaundice, Prednisone",
author = "Yan Bi and Hart, {Phil A.} and Ryan Law and Clain, {Jonathan E.} and Farnell, {Michael B.} and Gleeson, {Ferga C.} and Kendrick, {Michael L.} and Levy, {Mike J.} and Pearson, {Randall K.} and Petersen, {Bret Thomas} and Pisney, {Lisa D.} and Smyrk, {Thomas Christopher} and Naoki Takahashi and Mark Topazian and Vege, {Santhi Swaroop} and Chari, {Suresh T}",
year = "2016",
doi = "10.1016/j.pan.2016.03.017",
language = "English (US)",
journal = "Pancreatology",
issn = "1424-3903",
publisher = "S. Karger AG",

}

TY - JOUR

T1 - Obstructive jaundice in autoimmune pancreatitis can be safely treated with corticosteroids alone without biliary stenting

AU - Bi, Yan

AU - Hart, Phil A.

AU - Law, Ryan

AU - Clain, Jonathan E.

AU - Farnell, Michael B.

AU - Gleeson, Ferga C.

AU - Kendrick, Michael L.

AU - Levy, Mike J.

AU - Pearson, Randall K.

AU - Petersen, Bret Thomas

AU - Pisney, Lisa D.

AU - Smyrk, Thomas Christopher

AU - Takahashi, Naoki

AU - Topazian, Mark

AU - Vege, Santhi Swaroop

AU - Chari, Suresh T

PY - 2016

Y1 - 2016

N2 - Objective: Autoimmune pancreatitis (AIP) responds dramatically to corticosteroids treatment. We reviewed our experience to determine the safety and effectiveness of treating obstructive jaundice in definitive AIP with corticosteroids alone without biliary stenting. Methods: From our AIP database, we retrospectively identified type 1 AIP subjects whose jaundice was treated with corticosteroids alone without biliary stenting. Their medical records were reviewed and clinical data were evaluated to determine the outcomes. Results: Fifteen AIP subjects (87% male, mean age 68.4 years) were treated with corticosteroids at initial presentation (n = 8), first (n = 5) or subsequent (n = 2) relapse. Mean values (upper limit of normal, ULN) of liver tests prior to corticosteroids were aspartate aminotransferase (AST) 203.5u/l (4 × ULN), alanine aminotransferase (ALT) 325.8u/l (6 × ULN), alkaline phosphatase (ALP) 567.4u/l (5 × ULN), and total bilirubin (TB) 5.9 mg/dl (5.9 × ULN). At first follow-up (mean 4 days) the decrease was 54.9% for AST, 51.6% for ALT, 33% for ALP and 47.2% for TB (all p <0.05). After 15-45 days, all patients had normal AST, 3/15 had ALT > 1.5 × ULN, 1/15 had ALP > 1.5 × ULN, 1/15 had TB > 1.5 × ULN. No patient required biliary stent placement, or developed cholangitis or other infectious complications during steroid treatment. Conclusion: Under the supervision of an experienced pancreatologist and with close monitoring of patients, obstructive jaundice secondary to definitive AIP can be safely and effectively managed with corticosteroids alone, without the need for biliary stenting.

AB - Objective: Autoimmune pancreatitis (AIP) responds dramatically to corticosteroids treatment. We reviewed our experience to determine the safety and effectiveness of treating obstructive jaundice in definitive AIP with corticosteroids alone without biliary stenting. Methods: From our AIP database, we retrospectively identified type 1 AIP subjects whose jaundice was treated with corticosteroids alone without biliary stenting. Their medical records were reviewed and clinical data were evaluated to determine the outcomes. Results: Fifteen AIP subjects (87% male, mean age 68.4 years) were treated with corticosteroids at initial presentation (n = 8), first (n = 5) or subsequent (n = 2) relapse. Mean values (upper limit of normal, ULN) of liver tests prior to corticosteroids were aspartate aminotransferase (AST) 203.5u/l (4 × ULN), alanine aminotransferase (ALT) 325.8u/l (6 × ULN), alkaline phosphatase (ALP) 567.4u/l (5 × ULN), and total bilirubin (TB) 5.9 mg/dl (5.9 × ULN). At first follow-up (mean 4 days) the decrease was 54.9% for AST, 51.6% for ALT, 33% for ALP and 47.2% for TB (all p <0.05). After 15-45 days, all patients had normal AST, 3/15 had ALT > 1.5 × ULN, 1/15 had ALP > 1.5 × ULN, 1/15 had TB > 1.5 × ULN. No patient required biliary stent placement, or developed cholangitis or other infectious complications during steroid treatment. Conclusion: Under the supervision of an experienced pancreatologist and with close monitoring of patients, obstructive jaundice secondary to definitive AIP can be safely and effectively managed with corticosteroids alone, without the need for biliary stenting.

KW - Autoimmune pancreatitis

KW - Cholangitis

KW - Chronic pancreatitis

KW - ERCP (Endoscopic retrograde cholangiopancreatography)

KW - Obstructive jaundice

KW - Prednisone

UR - http://www.scopus.com/inward/record.url?scp=84963944114&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84963944114&partnerID=8YFLogxK

U2 - 10.1016/j.pan.2016.03.017

DO - 10.1016/j.pan.2016.03.017

M3 - Article

C2 - 27107633

AN - SCOPUS:84963944114

JO - Pancreatology

JF - Pancreatology

SN - 1424-3903

ER -