Abstract
We defined asymptomatic PBC (a-PBC) in which serum alkaline phosphatase level is less than twice the upper limit of normal range as "early PBC", and discriminated it from "classical PBC". In the present study, we investigated the laparoscopic findings in 17 cases of early PBC, and compared with those in 17 cases of classical PBC and 20 cases of symptomatic PBC (s-PBC). Numbers of patients in each histological staging (I, II, III and IV) according to Scheuer's classification were 14, 3, 0 and 0 in early PBC;10, 6, 1 and 0 in classical PBC, and 5, 6, 3 and 6 in s-PBC, respectively. Representative laparoscopic findings in overall PBC patients were reddish patch (48%), whitish marking (55%), and protuberance formation (59%). In patients with early PBC the presence of reddish patch and whitish marking was significantly low, and protuberance formation were relatively low as compared with patients with classical PBC. There were 6 patients (35%) with early PBC who showed no remarkable findings. Although we could not find any characteristic laparoscopic features in early PBC, at least one or two findings suggesting PBC were recognized in 9 of 17 (53%) patients. Of 10 patients who were laparoscopically folowed up, 6 showed some changes suggesting progression of disease on the liver surface. But 4 of the 6 patients were still asymptomatic. Therefore, it was suggested that some morphological findings precede the clinical findings in PBC.
