Effective steroid mini-pulse therapy for refractory biliary stenosis due to autoimmune pancreatitis

Abstract

A 62-year-old man visited another hospital, complaining of general fatigue and jaundice. Based on imaging studies, the diagnosis of autoimmune pancreatitis accompanied by biliary stenosis was made. After endoscopic biliary stenting, oral prednisolone was started. Although the diffuse pancreas awelling and pancreatic duct narrowing improved, the biliary stenosis showed no improvement. The patient was admitted to our hospital for further investigations. Because the patient refused re-treatment with high-dose oral prednisolone, we administrated steroid mini-pulse therapy, resulting in an improvement of the biliary stenosis. Although oral prednisolone was prescribed as a maintenance treatment, and was gradually reduced, the patient has remained asymptomatic without elevations of hepatobiliary enzymes or biliary stenosis.