A case of primary sclerosing cholangitis with a dominant stricture of extrahepatic bile duct successfully treated with endoscopic balloon dilation

Abstract

A 59 year-old man was diagnosed as having primary sclerosing cholangitis (PSC) according to elevated serum ALP and IgG levels, biliary stricture and irregularity evaluated by endoscopic retrograde cholangiopaucreatography (ERCP) , inflammatory cell infiltration and fibrosis not only surrounding interlobular bile ducts but within periportal parenchyma on histologic features 10 months before admission to our hospital. Although he had been treated well with oral administration of 600mg/day ursodeoxycholic acid (UDCA) , he suffered from cholangitis on admission March 2002 due to dominant stricture of the common bile ducts (CBD) . Since bile ducts carcinoma and syndromic autoimmune pancreatitis were ruled out by biliary exofoliative cytology, ERCP and CT, we safely repeated endoscopic balloon dilation of dominant stricture in the CBD 3 times at 6 atm for 60 seconds and administered 900mg/day UDCA and bezafibrate for peripheral biliary stenosis. After the treatment, appearance of dominant stricture of the CBD diminished and serum ALP and IgG levels decreased. Endoscopic treatment and medication presumably render him free of cholangitis symptom for 10 months.
Our successful experience indicated that endoscopic balloon dilation is an effective and noninvasive treatment for dominant strictures in the extrahepatic bile ducts with PSC.