Published online Aug 10, 2015. doi: 10.4253/wjge.v7.i10.920
Peer-review started: January 7, 2015
First decision: March 6, 2015
Revised: March 21, 2015
Accepted: July 11, 2015
Article in press: July 14, 2015
Published online: August 10, 2015
Processing time: 223 Days and 5.5 Hours
Endoscopy has important roles in the management of primary sclerosing cholangitis (PSC), ranging from narrowing down the differential diagnoses, screening for complications, determining prognosis and therapy. While the need for a diagnostic endoscopic retrograde cholangiopancreatography (ERCP) may be obviated by a positive magnetic resonance cholangiopancreatography (MRCP), a negative MRCP does not exclude PSC and may therefore necessitate an ERCP, which is traditionally regarded as the gold standard. In this editorial we have not covered the endoscopic management of inflammatory bowel disease in the context of PSC nor of endoscopic surveillance and treatment of portal hypertension complicating PSC.
Core tip: Primary sclerosing cholangitis is a cholestatic disease of unclear etiopathogenesis, often seen in association with inflammatory bowel disease. It is characterized by fibrosis of the intra and extra hepatic bile ducts, resulting in stricturing disease, predisposing to cholangiocarcinoma. Diagnosis requires a high index of clinical suspicion and is often made by magnetic resonance cholangiopancreatography in the appropriate clinical context, although endoscopic retrograde cholangiopancreatography remains the gold standard. The latter being invasive is seldom used as a diagnostic modality and is reserved for management of complications including dilatation and stenting of dominant and anastomotic strictures, brush cytology and for SpyGlass Cholangioscopy.