CPS Cholestasis zhongguo 2013 long(falk训讲).ppt

Role for endoscopic therapy and UDCA – more studies needed SSC: own experience with 54 cases Differences between survivors and those who died Predictors of death Did ERCP change anything? Management points: Endoscopy (+UDCA if cholestasis not too severe) can slow the process. Some cases improve. Most cases need OLT. Collection of bile for microbiology important AIC (IgG4) PSC: differential diagnosis – autoimmune cholangitis (AIC)/IgG4-Cholangitis Strassburg et al. Internist 2011 IgG4-associated cholangitis Clinical presentation: 75% with acute jaundice Diagnosis IgG4 140 mg/dL, (positive for plasma cells upon biopsy) imaging (MRCP, ERCP) HISORt (Histology, Imaging, Serology, Other organ involvement, Response to therapy) Therapy Steroids, (azathioprine, MMF) Bj?rnsson et al., Hepatology 2007 Umemura et al., Hepatology 2007 Ghazale et al., Gastroenterology 2008 Beuers Stiehl Lindor Mitchell (n=14) (n=20) (n=105) (n=26) Dose (mg/kg/d) 13 -15 10 -12 13 -15 20 Serum biochemisty + + + - - + Histology (+) (+) + Olsson (n=110) 17-23 - - - PSC: UDCA Placebo controlled studies EASL Practice Guideline 2009: Data suggests biochemical benefit (15-20mg/kg) but no general recommendation for therapy! Minor evidence for colonic dysplasia prevention corticosteroids or other immunosuppressants not indicated (only overlaps) Endoscopic dilatations under antibiotics, careful with stents Transplantation in advanced (cirrhosis) PSC and dysplasia of biliary tree Cholangiography + survival Hepatology, 2010 C B A Primary sclerosing cholangitis: endoscopic therapy Strassburg et al. Internist 2011 Liver tumors: metastases/hepatocellular carcinoma – increasing resection rates Pre-operative regeneration Portal vein embolization (2-stage resection/hepatectomy) In-situ split Downstaging/Downsizing neoadjuvant or regional chemotherapy (TACE) local ablation (RFA, cryosurgery, LITT) Internal radiotherapy (SIRT) RISK: Is the residual liver volume enough? Small