Endoscopic retrograde cholangiography does not reliably distinguish IgG4-associated cholangitis from primary sclerosing cholangitis or cholangiocarcinoma.

Abstract

BACKGROUND & AIMS:

Distinction of immunoglobulin G4-associated cholangitis (IAC) from primary sclerosing cholangitis (PSC) or cholangiocarcinoma is challenging. We aimed to assess the performance characteristics of endoscopic retrograde cholangiography (ERC) for the diagnosis of IAC.

METHODS:

Seventeen physicians from centers in the United States, Japan, and the United Kingdom, unaware of clinical data, reviewed 40 preselected ERCs of patients with IAC (n = 20), PSC (n = 10), and cholangiocarcinoma (n = 10). The performance characteristics of ERC for IAC diagnosis as well as the κ statistic for intraobserver and interobserver agreement were calculated.

RESULTS:

The overall specificity, sensitivity, and interobserver agreement for the diagnosis of IAC were 88%, 45%, and 0.18, respectively. Reviewer origin, specialty, or years of experience had no statistically significant effect on reporting success. The overall intraobserver agreement was fair (0.74). The operating characteristics of different ERC features for the diagnosis of IAC were poor.

CONCLUSIONS:

Despite high specificity of ERC for diagnosing IAC, sensitivity is poor, suggesting that many patients with IAC may be misdiagnosed with PSC or cholangiocarcinoma. Additional diagnostic strategies are likely to be vital in distinguishing these diseases.

• Authors: Evangelos Kalaitzakis, Michael Levy, Terumi Kamisawa, Gavin J Johnson, Todd H Baron, Mark D Topazian, Naoki Takahashi, Atsushi Kanno, Kazuichi Okazaki, Naoto Egawa, Kazushige Uchida, Kashif Sheikh, Zahir Amin, Tooru Shimosegawa, Neomal S Sandanayake, Nicholas I Church, Michael H Chapman, Stephen P Pereira, Suresh Chari, George J M Webster
• Journal: Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association (Clin Gastroenterol Hepatol) Vol. 9 Issue 9 Pg. 800-803.e2 (Sep 2011) ISSN: 1542-7714 [Electronic] United States
• PMID: 21699807 (Publication Type: Evaluation Study, Journal Article, Multicenter Study, Research Support, Non-U.S. Gov't)
• Copyright: Copyright © 2011 AGA Institute. Published by Elsevier Inc. All rights reserved.

Chemical References

• Immunoglobulin G

Topics

• Cholangiocarcinoma (diagnosis)
• Cholangiopancreatography, Endoscopic Retrograde
• Cholangitis (chemically induced, diagnosis, etiology)
• Diagnosis, Differential
• Diagnostic Errors (statistics & numerical data)
• Humans
• Immunoglobulin G (administration & dosage, adverse effects)
• Japan
• Sensitivity and Specificity
• United Kingdom
• United States