Digestive Diseases and Sciences

, Volume 60, Issue 5, pp 1178–1182 | Cite as

Non-MalIg(G4)nant Biliary Obstruction: When the Pill Is Mightier than the Knife

  • Monica M. Dua
  • Motaz Qadan
  • Glen A. Lutchman
  • Walter G. Park
  • George Triadafilopoulos
  • Brendan C. Visser
Stanford Multidisciplinary Seminars

Case Presentation and Evolution

A 48-year-old man was initially evaluated in a community hospital with jaundice and elevated liver enzymes (bilirubin 9.1 mg/dL and alkaline phosphatase of 682 U/L). Intrahepatic ductal dilatation had been diagnosed with computed tomography (CT); endoscopic retrograde cholangiopancreatography (ERCP) confirmed this and documented a common bile duct stricture which was stented. Pathology from the brushings indicated cellular atypia but no clear evidence of malignancy. He developed post-procedural pancreatitis and a pancreatic pseudocyst that required prolonged drainage, delaying for several months further evaluation of his common bile duct stricture. Once the pancreatic inflammation had subsided, diagnostic laparoscopy was considered in order to further characterize the etiology of his stricture; however, the operation was aborted as it was felt that the patient had extensive cholangiocarcinoma.

He was ultimately discharged but readmitted for persistent...


Bile Duct Cholangiocarcinoma Steroid Therapy Primary Sclerosing Cholangitis Obstructive Jaundice 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Conflict of interest



  1. 1.
    Kamisawa T, Okamoto A. IgG4-related sclerosing disease. World J Gastroenterol. 2008;14:3948–3955.CrossRefPubMedCentralPubMedGoogle Scholar
  2. 2.
    Kamisawa T, Okamoto A. Autoimmune pancreatitis: proposal of IgG4-related sclerosing disease. J Gastroenterol. 2006;41:613–625.CrossRefPubMedCentralPubMedGoogle Scholar
  3. 3.
    Kamisawa T, Satake K. Clinical management of autoimmune pancreatitis. Adv Med Sci. 2007;52:61–65.PubMedGoogle Scholar
  4. 4.
    Chari ST, Smyrk TC, Levy MJ, Topazian MD, Takahashi N, et al. Diagnosis of autoimmune pancreatitis: the Mayo Clinic experience. Clin Gastroenterol Hepatol. 2006;4:1010–1016.CrossRefPubMedGoogle Scholar
  5. 5.
    Nakazawa T, Naitoh I, Hayashi K, Miyabe K, Simizu S, et al. Diagnosis of IgG4-related sclerosing cholangitis. World J Gastroenterol. 2013;19:7661–7670.CrossRefPubMedCentralPubMedGoogle Scholar
  6. 6.
    Nishimori I, Otsuki M. Autoimmune pancreatitis and IgG4-associated sclerosing cholangitis. Best Prac Res Clin Gastroenterol. 2008;23:11–23.CrossRefGoogle Scholar
  7. 7.
    Maeda M, Shimada K. A case of IgG4-related sclerosing cholangitis mimicking and intrahepatic cholangiocellular carcinoma. Jpn J Clin Oncol. 2012;42:153.CrossRefPubMedGoogle Scholar
  8. 8.
    Okazaki K, Kawa S, Kamisawa T, Naruse S, Tanaka S, et al. Clinical diagnostic criteria of autoimmune pancreatitis: revised proposal. J Gastroenterol. 2006;41:626–631.CrossRefPubMedCentralPubMedGoogle Scholar
  9. 9.
    Ohara H, Okazaki K, Tsubouchi H, Inui K, Kawa S, et al. Clinical diagnostic criteria of IgG4-related sclerosing cholangitis. J Hepatobiliary Pancreat Sci. 2012;19:536–542.CrossRefPubMedGoogle Scholar
  10. 10.
    Nakazawa T, Ohara H, Sano H, Ando T, Joh T. Schematic classification of sclerosing cholangitis with autoimmune pancreatitis by cholangiography. Pancreas. 2006;32:229.CrossRefPubMedGoogle Scholar
  11. 11.
    Kamisawa T, Takuma K, Anjiki H, Egawa N, Kurata M, et al. Sclerosing cholangitis associated with autoimmune pancreatitis differs from primary sclerosing cholangitis. World J Gastroenterol. 2009;15:2357–2360.CrossRefPubMedCentralPubMedGoogle Scholar
  12. 12.
    Kamisawa T, Okazaki K, Kawa S, Ito T, Inui K, et al. Amendment of the Japanese Consensus Guidelines for Autoimmune Pancreatitis, 2013 III. Treatment and prognosis of autoimmune pancreatitis. J Gastroenterol. 2014;49:961–970.CrossRefPubMedGoogle Scholar
  13. 13.
    Hart PA, Kamisawa T, Brugge WR, Chung JB, Culver EL, et al. Long-term outcomes of autoimmune pancreatitis: a multicentre, international analysis. Gut. 2013;62:1771–1776.CrossRefPubMedCentralPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  • Monica M. Dua
    • 1
  • Motaz Qadan
    • 1
  • Glen A. Lutchman
    • 2
  • Walter G. Park
    • 2
  • George Triadafilopoulos
    • 2
  • Brendan C. Visser
    • 1
  1. 1.Division of Surgical Oncology, Department of SurgeryStanford University Medical CenterStanfordUSA
  2. 2.Department of MedicineStanford University Medical CenterStanfordUSA

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