Role of Endoscopic Procedures in the Diagnosis of IgG4-Related Pancreatobiliary Disease

Published on Jan 1, 2021in Chonnam Medical Journal
· DOI :10.4068/CMJ.2021.57.1.44
Ye-Ji Jung (Sacred Heart Hospital), Sung-Hoon Moon8
Estimated H-index: 8
(Hallym University)
+ 0 AuthorsMyung-Hwan Kim89
Estimated H-index: 89
(UOU: University of Ulsan)
The emergence of the disease entity of glucocorticoid-responsive systemic immunoglobulin G4 (IgG4)-related pancreatobiliary disease has generated substantial attention among the international gastroenterology society. IgG4-related pancreatobiliary disease includes type 1 autoimmune pancreatitis (AIP) and IgG4-related sclerosing cholangitis (IgG4-SC). The typical manifestations of IgG4-related pancreatobiliary disease are cholestatic liver dysfunction, obstructive jaundice, and weight loss, although it may present with no clinical symptoms. Since it mimics tumors on imaging, AIP/IgG4-SC may often be misdiagnosed as pancreatic or biliary cancer. The endoscopic armamentarium for the diagnosis of IgG4-related pancreatobiliary disease includes endoscopic ultrasonography, intraductal ultrasonography, endoscopic retrograde cholangiopancreatography, and cholangioscopy. The role of endoscopic tissue acquisition is two-fold in the diagnosis of IgG4-related pancreatobiliary disease: exclusion of cancer and procurement of histopathological proof for diagnosis of AIP/IgG4-SC, which can also be achieved by adding the immunohistochemistry for IgG4. Our review article addresses the role of various endoscopic examinations in diagnosing IgG4-related pancreatobiliary disease, focusing on the differentiation of this condition from pancreatobiliary malingnancies.
#1Seung Bae Yoon (Catholic University of Korea)H-Index: 10
#2Sung-Hoon Moon (Sacred Heart Hospital)H-Index: 8
Last. Myung-Hwan Kim (UOU: University of Ulsan)H-Index: 89
view all 5 authors...
Abstract Background The diagnosis of autoimmune pancreatitis (AIP) remains challenging, especially when serum IgG4 is normal or imaging features are indeterminate. We performed a systematic review and meta-analysis to evaluate the performance of IgG4 immunostaining of pancreatic, biliary, and ampullary tissues as a diagnostic aid for AIP. Methods A comprehensive literature search of the PubMed, EMBASE, and Ovid MEDLINE databases was conducted until February 2020. The methodological quality of ea...
2 CitationsSource
#1Seung Bae Yoon (Catholic University of Korea)H-Index: 10
#2Sung-Hoon Moon (Hallym University)H-Index: 8
Last. Myung-Hwan Kim (UOU: University of Ulsan)H-Index: 89
view all 5 authors...
BACKGROUND Endoscopic ultrasound (EUS) is recommended for guiding the acquisition of pancreatic tissue in patients with suspected autoimmune pancreatitis (AIP). Data comparing EUS-guided fine needle aspiration (FNA) and fine needle biopsy (FNB) sampling in the diagnosis of AIP are limited. METHODS A comprehensive literature search of the PubMed, EMBASE, and Ovid MEDLINE databases was conducted until April 2020. The pooled rates of diagnostic yield for the histologic criteria of AIP, histologic t...
3 CitationsSource
#1Shigeyuki Kawa (Matsumoto Dental University)H-Index: 67
#2Terumi KamisawaH-Index: 77
Last. Kazuichi OkazakiH-Index: 85
view all 7 authors...
17 CitationsSource
#1Antonio Facciorusso (University of Foggia)H-Index: 19
#2Sachin Wani (Anschutz Medical Campus)H-Index: 68
Last. Siddharth Singh (UCSD: University of California, San Diego)H-Index: 67
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Abstract Background and Aims Variable diagnostic performance of sampling techniques during EUS-guided tissue acquisition of solid pancreatic masses based on needle type [fine-needle aspiration (FNA) versus fine-needle biopsy (FNB)] and gauge (19-gauge vs 22-gauge vs 25-gauge) has been reported. We performed a systematic review with network meta-analysis to compare the diagnostic accuracy of EUS-guided techniques for sampling solid pancreatic masses. Methods Through a systematic literature review...
32 CitationsSource
#1Terumi KamisawaH-Index: 77
#2Takahiro NakazawaH-Index: 29
Last. Masahiro Yoshida (International University of Health and Welfare)H-Index: 43
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: IgG4-related sclerosing cholangitis (IgG4-SC) is a distinct type of cholangitis frequently associated with autoimmune pancreatitis and currently recognized as a biliary manifestation of IgG4-related disease. Although clinical diagnostic criteria of IgG4-SC were established in 2012, differential diagnosis from primary sclerosing cholangitis and cholangiocarcinoma is sometimes difficult. Furthermore, no practical guidelines for IgG4-SC are available. Because the evidence level of most articles r...
43 CitationsSource
#1Min Keun Cho (UOU: University of Ulsan)H-Index: 3
#2Sung-Hoon Moon (Sacred Heart Hospital)H-Index: 8
Last. Myung-Hwan Kim (UOU: University of Ulsan)H-Index: 89
view all 10 authors...
Background/Aims: Differentially diagnosing focal-type autoimmune pancreatitis (f-AIP) and pancreatic cancer (PC) is challenging. Contrast-enhanced harmonic endoscopic ultrasound (CEH-EUS) may provide information for differentiating pancreatic masses. In this study, we evaluated the usefulness of CEH-EUS in differentiating f-AIP from PC. Methods: Data were collected prospectively and analyzed on patients who underwent CEH-EUS between May 2014 and May 2015. Eighty consecutive patients were diagnos...
11 CitationsSource
#1Sung-Hoon Moon (Sacred Heart Hospital)H-Index: 8
#2Myung-Hwan Kim (Asan Medical Center)H-Index: 89
Last. Sung Koo Lee (UOU: University of Ulsan)H-Index: 69
view all 12 authors...
Background Recent research has shown that a substantial number of patients with primary sclerosing cholangitis (PSC) can also have elevated serum/tissue IgG4. The aim of our study was to develop a simple scoring system for the discrimination of IgG4-related sclerosing cholangits (IgG4-SC) from PSC.
13 CitationsSource
#1Andre IgneeH-Index: 39
#2Nathan S. S. Atkinson (University of Oxford)H-Index: 15
Last. Christoph F. DietrichH-Index: 74
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Endoscopic ultrasound (EUS) plays an important role in imaging of the mediastinum and abdominal organs. Since the introduction of US contrast agents (UCA) for transabdominal US, attempts have been made to apply contrast-enhanced US techniques also to EUS. Since 2003, specific contrast-enhanced imaging was possible using EUS. Important studies have been published regarding contrast-enhanced EUS and the characterization of focal pancreatic lesions, lymph nodes, and subepithelial tumors. In this ma...
36 CitationsSource
#1Itaru Naitoh (Nagoya City University)H-Index: 22
#2Takahiro Nakazawa (Nagoya City University)H-Index: 29
Last. Takashi Joh (Nagoya City University)H-Index: 69
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Abstract Background Endoscopic retrograde cholangiopancreatography (ERCP) is frequently performed for the diagnosis and treatment of type 1 autoimmune pancreatitis (AIP). However, the prevalence of ERCP-related adverse events in patients with type 1 AIP has not been evaluated. We aimed to clarify the feasibility of ERCP in patients with type 1 AIP. Methods We retrospectively reviewed 82 consecutive ERCP procedures performed in patients with type 1 AIP from 2004 to 2014 in one university hospital...
6 CitationsSource
#1Anahita Sadeghi (Tehran University of Medical Sciences)H-Index: 7
#2Mehdi Mohamadnejad (Tehran University of Medical Sciences)H-Index: 27
Last. Mohamad A. EloubeidiH-Index: 67
view all 7 authors...
Background and Aims EUS-guided FNA (EUS-FNA) is increasingly being used for tissue diagnosis of extrahepatic biliary strictures. The aim of this study was to determine the diagnostic yield of EUS-FNA in malignant biliary strictures. Methods A comprehensive literature review was carried out by 2 reviewers for studies evaluating the accuracy of EUS-FNA in biliary stricture. A meta-analysis was performed to determine the pooled estimates of sensitivity, specificity, likelihood ratios, and diagnosti...
49 CitationsSource
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