ENDOSCOPIC THERAPY IN PRIMARY SCLEROSING CHOLANGITIS

The development of therapeutic endoscopic retrograde cholangiopancreatography (ERCP) techniques can avoid the necessity for more invasive transhepatic and surgical methods of improving biliary drainage in primary drainage in sclerosing cholangitis (PSC). Predominant extrahepatic obstruction, whether caused by sludge, stone and/or strictures, can be managed by temporary nasobiliary drainage. More long-term improvement can be obtained by repeated endoscopic balloon dilatations and by the insertion of indwelling biliary prostheses. Where continued hepatocellular impairment is seen, despite endoscopic manoeuvres to provide good biliary drainage, liver transplantation should be considered.