Cholangiographic findings in deteriorating XXXX .

@entity1 @entity75 @entity648 @entity991 @entity201 @entity255
BACKGROUND AND STUDY AIMS: The evolution of @entity991 ( @entity991 ) is difficult to predict, and ERCP may be helpful in diagnosing its complications and treating them. Few descriptions of cholangiographic findings during the course of the disease have yet appeared. We report here on our experience in the management and follow-up by ERCP of six @entity1 with deteriorating @entity991 . @entity1 AND METHODS: Between 1981 and 1992, @entity991 was diagnosed in 18 @entity1 . Clinical, biochemical, and cholangiographic findings were recorded during the follow-up period. An initial group of 12 @entity1 had a good clinical and biochemical course (mean 56 months) and did not require systematic control ERCPs. A second group of six @entity1 , showing cholangiographic features similar to those of the first group at presentation, developed clinical and biochemical deterioration within a mean period of 43 months (range 6-96). RESULTS: These six @entity1 had a significant elevation of serum @entity648 and at ERCP showed worsening bile duct lesions, with marked strictures and a subsequent increase in the maximum duct diameter in both the extrahepatic and intrahepatic ducts compared to the initial ERCPs. In two of these six @entity1 , the strictures were due to a superimposed @entity201 . Endoscopic drainage was unsuccessful, transplantation impracticable due to extrahepatic spread, and both @entity1 died three and five months, respectively, after diagnosis of @entity201 . By contrast, four @entity1 with dominant extrahepatic duct involvement benefited from endoscopic procedures (mean follow-up 19 months) without any recurrence of @entity255 and without requiring long-term antimicrobial treatment. The follow-up checks included regular ERCPs performed every six months for duct and stent assessment, and cytology brushing. CONCLUSIONS: Since there are no effective means of early and accurate detection of @entity201 , the use of ERCP to compare the course of @entity75 over time may be of interest. @entity1 with extrahepatic duct involvement may benefit from endoscopic therapy. By contrast, in @entity1 with dominant intrahepatic duct disease and a deteriorating clinical status, attempts at endoscopic therapy are not helpful, and liver transplantation needs to be considered promptly.
