Primary sclerosing cholangitis: outcome of patients undergoing restorative proctocolecetomy for ulcerative colitis
Purpose The prevalence of primary sclerosing cholangitis (PSC) among patients with ulcerative colitis needing proctocolectomy is about 12%. The study aim was to evaluate the progression of the liver disease after surgery. Methods PSC progression in 68 patients with UC after restorative proctocolecto...
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| Veröffentlicht in: | International journal of colorectal disease 2009-10, Vol.24 (10), p.1169-1174 |
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| creator | Lepistö, Anna Kivistö, Sari Kivisaari, Leena Arola, Johanna Järvinen, Heikki J |
| description | Purpose The prevalence of primary sclerosing cholangitis (PSC) among patients with ulcerative colitis needing proctocolectomy is about 12%. The study aim was to evaluate the progression of the liver disease after surgery. Methods PSC progression in 68 patients with UC after restorative proctocolectomy was evaluated after a median follow-up of 11 years (range 0 to 21). Magnetic resonance imaging (MRI) of the liver, histological examination of a core needle liver specimen, and liver function tests were used in addition to clinical history. Results Of the 68 patients, 30 participated in follow-up examinations. Ductal changes in MRI suggesting a diagnosis of PSC occurred in 21 (72%) of them. One carcinoma of the gallbladder was found in MRI. Histopathologic changes suggesting PSC were observable in 15 (50%) patients. Compared to stage in peroperative biopsies taken at proctocolectomy, PSC stage increased in four (13%) patients, decreased in 15 (50%), and remained unchanged in 11 (37%). Immunohistochemical staining for cytoceratin-7 in hepatocytes was positive in nine (30%) indicating cholestasis. After IPAA surgery, five patients underwent liver transplantation at 1, 1, 5, 6, and 11 years, respectively. Of the 68, six patients have, to date, developed cholangiocarcinoma. Conclusions Progression of PSC in patients with minor ductal changes at the time of restorative proctocolectomy is unlikely. Those patients with more advanced disease at surgery are at risk for disease progression and liver transplantation. We lack accurate diagnostic methods to detect premalignant changes of the biliary epithelium. |
| doi_str_mv | 10.1007/s00384-009-0773-4 |
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| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_734018081</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>734018081</sourcerecordid><originalsourceid>FETCH-LOGICAL-c424t-a61d3a478951f2b7f2e2a94c52d393ace6cf89df8936d0012d5d7d68030ba553</originalsourceid><addsrcrecordid>eNp9kVuL1TAUhYMozpnRH-CLFmHwqZqde-ZNBm8woOD4HHJyqR3a5pi0wvx7U1oc8MGHEML69s7aeyH0AvBbwFi-KxhTxVqMdYulpC17hA7AKGmBCPIYHTBI3YLm6gydl3KH61tI9hSdgRZUcEkPKH_L_WjzfVPcEHIq_dQ17mca7NT1c1-umrTMLo2hSbE52bkP01yaZfIhd2llcyhzylX4HZpTTm5OLg3BhTmN901MuVkGF3a9KmvPZ-hJtEMJz_f7At1-_HB7_bm9-frpy_X7m9YxwubWCvDUMqk0h0iOMpJArGaOE081tS4IF5X29VDh62jEcy-9UJjio-WcXqA3W9tq69dSbZqxLy4MdbSQlmIkZRgUVlDJ1_-Qd2nJU_VmCAiOGVesQrBBrm6p5BDNaducAWzWNMyWhqlpmDUNs9a83BsvxzH4h4p9_RW43AFbnB1itpPry1-OgAagWleObFyp0tSF_ODwf7-_2oqiTcZ2uTb-8Z1goBiEpIoK-gcYbK1t</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>216504584</pqid></control><display><type>article</type><title>Primary sclerosing cholangitis: outcome of patients undergoing restorative proctocolecetomy for ulcerative colitis</title><source>MEDLINE</source><source>SpringerLink Journals - AutoHoldings</source><creator>Lepistö, Anna ; Kivistö, Sari ; Kivisaari, Leena ; Arola, Johanna ; Järvinen, Heikki J</creator><creatorcontrib>Lepistö, Anna ; Kivistö, Sari ; Kivisaari, Leena ; Arola, Johanna ; Järvinen, Heikki J</creatorcontrib><description>Purpose The prevalence of primary sclerosing cholangitis (PSC) among patients with ulcerative colitis needing proctocolectomy is about 12%. The study aim was to evaluate the progression of the liver disease after surgery. Methods PSC progression in 68 patients with UC after restorative proctocolectomy was evaluated after a median follow-up of 11 years (range 0 to 21). Magnetic resonance imaging (MRI) of the liver, histological examination of a core needle liver specimen, and liver function tests were used in addition to clinical history. Results Of the 68 patients, 30 participated in follow-up examinations. Ductal changes in MRI suggesting a diagnosis of PSC occurred in 21 (72%) of them. One carcinoma of the gallbladder was found in MRI. Histopathologic changes suggesting PSC were observable in 15 (50%) patients. Compared to stage in peroperative biopsies taken at proctocolectomy, PSC stage increased in four (13%) patients, decreased in 15 (50%), and remained unchanged in 11 (37%). Immunohistochemical staining for cytoceratin-7 in hepatocytes was positive in nine (30%) indicating cholestasis. After IPAA surgery, five patients underwent liver transplantation at 1, 1, 5, 6, and 11 years, respectively. Of the 68, six patients have, to date, developed cholangiocarcinoma. Conclusions Progression of PSC in patients with minor ductal changes at the time of restorative proctocolectomy is unlikely. Those patients with more advanced disease at surgery are at risk for disease progression and liver transplantation. We lack accurate diagnostic methods to detect premalignant changes of the biliary epithelium.</description><identifier>ISSN: 0179-1958</identifier><identifier>EISSN: 1432-1262</identifier><identifier>DOI: 10.1007/s00384-009-0773-4</identifier><identifier>PMID: 19636573</identifier><identifier>CODEN: IJCDE6</identifier><language>eng</language><publisher>Berlin/Heidelberg: Berlin/Heidelberg : Springer-Verlag</publisher><subject>Anastomosis, Surgical ; Biological and medical sciences ; Biopsy ; Cholangiocarcinoma - complications ; Cholangiocarcinoma - drug therapy ; Cholangiocarcinoma - pathology ; Cholangitis, Sclerosing - complications ; Cholangitis, Sclerosing - drug therapy ; Cholangitis, Sclerosing - etiology ; Colitis, Ulcerative - complications ; Colitis, Ulcerative - drug therapy ; Colitis, Ulcerative - surgery ; Colonic Pouches ; Female ; Gastroenterology ; Gastroenterology. Liver. Pancreas. Abdomen ; Hepatology ; Humans ; Internal Medicine ; Liver - pathology ; Liver Function Tests ; Liver Transplantation ; Liver. Biliary tract. Portal circulation. Exocrine pancreas ; Magnetic Resonance Imaging ; Male ; Medical sciences ; Medicine ; Medicine & Public Health ; Original Article ; Other diseases. Semiology ; Proctocolectomy, Restorative - adverse effects ; Proctology ; Stomach, duodenum, intestine, rectum, anus ; Stomach. Duodenum. Small intestine. Colon. Rectum. Anus ; Surgery ; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases ; Surgery of the digestive system ; Treatment Outcome ; Ursodeoxycholic Acid - therapeutic use</subject><ispartof>International journal of colorectal disease, 2009-10, Vol.24 (10), p.1169-1174</ispartof><rights>Springer-Verlag 2009</rights><rights>2009 INIST-CNRS</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c424t-a61d3a478951f2b7f2e2a94c52d393ace6cf89df8936d0012d5d7d68030ba553</citedby><cites>FETCH-LOGICAL-c424t-a61d3a478951f2b7f2e2a94c52d393ace6cf89df8936d0012d5d7d68030ba553</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s00384-009-0773-4$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s00384-009-0773-4$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>314,778,782,27907,27908,41471,42540,51302</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=21911399$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/19636573$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Lepistö, Anna</creatorcontrib><creatorcontrib>Kivistö, Sari</creatorcontrib><creatorcontrib>Kivisaari, Leena</creatorcontrib><creatorcontrib>Arola, Johanna</creatorcontrib><creatorcontrib>Järvinen, Heikki J</creatorcontrib><title>Primary sclerosing cholangitis: outcome of patients undergoing restorative proctocolecetomy for ulcerative colitis</title><title>International journal of colorectal disease</title><addtitle>Int J Colorectal Dis</addtitle><addtitle>Int J Colorectal Dis</addtitle><description>Purpose The prevalence of primary sclerosing cholangitis (PSC) among patients with ulcerative colitis needing proctocolectomy is about 12%. The study aim was to evaluate the progression of the liver disease after surgery. Methods PSC progression in 68 patients with UC after restorative proctocolectomy was evaluated after a median follow-up of 11 years (range 0 to 21). Magnetic resonance imaging (MRI) of the liver, histological examination of a core needle liver specimen, and liver function tests were used in addition to clinical history. Results Of the 68 patients, 30 participated in follow-up examinations. Ductal changes in MRI suggesting a diagnosis of PSC occurred in 21 (72%) of them. One carcinoma of the gallbladder was found in MRI. Histopathologic changes suggesting PSC were observable in 15 (50%) patients. Compared to stage in peroperative biopsies taken at proctocolectomy, PSC stage increased in four (13%) patients, decreased in 15 (50%), and remained unchanged in 11 (37%). Immunohistochemical staining for cytoceratin-7 in hepatocytes was positive in nine (30%) indicating cholestasis. After IPAA surgery, five patients underwent liver transplantation at 1, 1, 5, 6, and 11 years, respectively. Of the 68, six patients have, to date, developed cholangiocarcinoma. Conclusions Progression of PSC in patients with minor ductal changes at the time of restorative proctocolectomy is unlikely. Those patients with more advanced disease at surgery are at risk for disease progression and liver transplantation. We lack accurate diagnostic methods to detect premalignant changes of the biliary epithelium.</description><subject>Anastomosis, Surgical</subject><subject>Biological and medical sciences</subject><subject>Biopsy</subject><subject>Cholangiocarcinoma - complications</subject><subject>Cholangiocarcinoma - drug therapy</subject><subject>Cholangiocarcinoma - pathology</subject><subject>Cholangitis, Sclerosing - complications</subject><subject>Cholangitis, Sclerosing - drug therapy</subject><subject>Cholangitis, Sclerosing - etiology</subject><subject>Colitis, Ulcerative - complications</subject><subject>Colitis, Ulcerative - drug therapy</subject><subject>Colitis, Ulcerative - surgery</subject><subject>Colonic Pouches</subject><subject>Female</subject><subject>Gastroenterology</subject><subject>Gastroenterology. Liver. Pancreas. Abdomen</subject><subject>Hepatology</subject><subject>Humans</subject><subject>Internal Medicine</subject><subject>Liver - pathology</subject><subject>Liver Function Tests</subject><subject>Liver Transplantation</subject><subject>Liver. Biliary tract. Portal circulation. Exocrine pancreas</subject><subject>Magnetic Resonance Imaging</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Original Article</subject><subject>Other diseases. Semiology</subject><subject>Proctocolectomy, Restorative - adverse effects</subject><subject>Proctology</subject><subject>Stomach, duodenum, intestine, rectum, anus</subject><subject>Stomach. Duodenum. Small intestine. Colon. Rectum. Anus</subject><subject>Surgery</subject><subject>Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases</subject><subject>Surgery of the digestive system</subject><subject>Treatment Outcome</subject><subject>Ursodeoxycholic Acid - therapeutic use</subject><issn>0179-1958</issn><issn>1432-1262</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2009</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><recordid>eNp9kVuL1TAUhYMozpnRH-CLFmHwqZqde-ZNBm8woOD4HHJyqR3a5pi0wvx7U1oc8MGHEML69s7aeyH0AvBbwFi-KxhTxVqMdYulpC17hA7AKGmBCPIYHTBI3YLm6gydl3KH61tI9hSdgRZUcEkPKH_L_WjzfVPcEHIq_dQ17mca7NT1c1-umrTMLo2hSbE52bkP01yaZfIhd2llcyhzylX4HZpTTm5OLg3BhTmN901MuVkGF3a9KmvPZ-hJtEMJz_f7At1-_HB7_bm9-frpy_X7m9YxwubWCvDUMqk0h0iOMpJArGaOE081tS4IF5X29VDh62jEcy-9UJjio-WcXqA3W9tq69dSbZqxLy4MdbSQlmIkZRgUVlDJ1_-Qd2nJU_VmCAiOGVesQrBBrm6p5BDNaducAWzWNMyWhqlpmDUNs9a83BsvxzH4h4p9_RW43AFbnB1itpPry1-OgAagWleObFyp0tSF_ODwf7-_2oqiTcZ2uTb-8Z1goBiEpIoK-gcYbK1t</recordid><startdate>20091001</startdate><enddate>20091001</enddate><creator>Lepistö, Anna</creator><creator>Kivistö, Sari</creator><creator>Kivisaari, Leena</creator><creator>Arola, Johanna</creator><creator>Järvinen, Heikki J</creator><general>Berlin/Heidelberg : Springer-Verlag</general><general>Springer-Verlag</general><general>Springer</general><general>Springer Nature B.V</general><scope>FBQ</scope><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7T5</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>H94</scope><scope>K9.</scope><scope>M0S</scope><scope>M1P</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope></search><sort><creationdate>20091001</creationdate><title>Primary sclerosing cholangitis: outcome of patients undergoing restorative proctocolecetomy for ulcerative colitis</title><author>Lepistö, Anna ; Kivistö, Sari ; Kivisaari, Leena ; Arola, Johanna ; Järvinen, Heikki J</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c424t-a61d3a478951f2b7f2e2a94c52d393ace6cf89df8936d0012d5d7d68030ba553</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2009</creationdate><topic>Anastomosis, Surgical</topic><topic>Biological and medical sciences</topic><topic>Biopsy</topic><topic>Cholangiocarcinoma - complications</topic><topic>Cholangiocarcinoma - drug therapy</topic><topic>Cholangiocarcinoma - pathology</topic><topic>Cholangitis, Sclerosing - complications</topic><topic>Cholangitis, Sclerosing - drug therapy</topic><topic>Cholangitis, Sclerosing - etiology</topic><topic>Colitis, Ulcerative - complications</topic><topic>Colitis, Ulcerative - drug therapy</topic><topic>Colitis, Ulcerative - surgery</topic><topic>Colonic Pouches</topic><topic>Female</topic><topic>Gastroenterology</topic><topic>Gastroenterology. Liver. Pancreas. Abdomen</topic><topic>Hepatology</topic><topic>Humans</topic><topic>Internal Medicine</topic><topic>Liver - pathology</topic><topic>Liver Function Tests</topic><topic>Liver Transplantation</topic><topic>Liver. Biliary tract. Portal circulation. Exocrine pancreas</topic><topic>Magnetic Resonance Imaging</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Original Article</topic><topic>Other diseases. Semiology</topic><topic>Proctocolectomy, Restorative - adverse effects</topic><topic>Proctology</topic><topic>Stomach, duodenum, intestine, rectum, anus</topic><topic>Stomach. Duodenum. Small intestine. Colon. Rectum. Anus</topic><topic>Surgery</topic><topic>Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases</topic><topic>Surgery of the digestive system</topic><topic>Treatment Outcome</topic><topic>Ursodeoxycholic Acid - therapeutic use</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Lepistö, Anna</creatorcontrib><creatorcontrib>Kivistö, Sari</creatorcontrib><creatorcontrib>Kivisaari, Leena</creatorcontrib><creatorcontrib>Arola, Johanna</creatorcontrib><creatorcontrib>Järvinen, Heikki J</creatorcontrib><collection>AGRIS</collection><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Immunology Abstracts</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><jtitle>International journal of colorectal disease</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Lepistö, Anna</au><au>Kivistö, Sari</au><au>Kivisaari, Leena</au><au>Arola, Johanna</au><au>Järvinen, Heikki J</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Primary sclerosing cholangitis: outcome of patients undergoing restorative proctocolecetomy for ulcerative colitis</atitle><jtitle>International journal of colorectal disease</jtitle><stitle>Int J Colorectal Dis</stitle><addtitle>Int J Colorectal Dis</addtitle><date>2009-10-01</date><risdate>2009</risdate><volume>24</volume><issue>10</issue><spage>1169</spage><epage>1174</epage><pages>1169-1174</pages><issn>0179-1958</issn><eissn>1432-1262</eissn><coden>IJCDE6</coden><abstract>Purpose The prevalence of primary sclerosing cholangitis (PSC) among patients with ulcerative colitis needing proctocolectomy is about 12%. The study aim was to evaluate the progression of the liver disease after surgery. Methods PSC progression in 68 patients with UC after restorative proctocolectomy was evaluated after a median follow-up of 11 years (range 0 to 21). Magnetic resonance imaging (MRI) of the liver, histological examination of a core needle liver specimen, and liver function tests were used in addition to clinical history. Results Of the 68 patients, 30 participated in follow-up examinations. Ductal changes in MRI suggesting a diagnosis of PSC occurred in 21 (72%) of them. One carcinoma of the gallbladder was found in MRI. Histopathologic changes suggesting PSC were observable in 15 (50%) patients. Compared to stage in peroperative biopsies taken at proctocolectomy, PSC stage increased in four (13%) patients, decreased in 15 (50%), and remained unchanged in 11 (37%). Immunohistochemical staining for cytoceratin-7 in hepatocytes was positive in nine (30%) indicating cholestasis. After IPAA surgery, five patients underwent liver transplantation at 1, 1, 5, 6, and 11 years, respectively. Of the 68, six patients have, to date, developed cholangiocarcinoma. Conclusions Progression of PSC in patients with minor ductal changes at the time of restorative proctocolectomy is unlikely. Those patients with more advanced disease at surgery are at risk for disease progression and liver transplantation. We lack accurate diagnostic methods to detect premalignant changes of the biliary epithelium.</abstract><cop>Berlin/Heidelberg</cop><pub>Berlin/Heidelberg : Springer-Verlag</pub><pmid>19636573</pmid><doi>10.1007/s00384-009-0773-4</doi><tpages>6</tpages></addata></record> |
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| subjects | Anastomosis, Surgical Biological and medical sciences Biopsy Cholangiocarcinoma - complications Cholangiocarcinoma - drug therapy Cholangiocarcinoma - pathology Cholangitis, Sclerosing - complications Cholangitis, Sclerosing - drug therapy Cholangitis, Sclerosing - etiology Colitis, Ulcerative - complications Colitis, Ulcerative - drug therapy Colitis, Ulcerative - surgery Colonic Pouches Female Gastroenterology Gastroenterology. Liver. Pancreas. Abdomen Hepatology Humans Internal Medicine Liver - pathology Liver Function Tests Liver Transplantation Liver. Biliary tract. Portal circulation. Exocrine pancreas Magnetic Resonance Imaging Male Medical sciences Medicine Medicine & Public Health Original Article Other diseases. Semiology Proctocolectomy, Restorative - adverse effects Proctology Stomach, duodenum, intestine, rectum, anus Stomach. Duodenum. Small intestine. Colon. Rectum. Anus Surgery Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases Surgery of the digestive system Treatment Outcome Ursodeoxycholic Acid - therapeutic use |
| title | Primary sclerosing cholangitis: outcome of patients undergoing restorative proctocolecetomy for ulcerative colitis |
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