Dominant strictures in patients with primary sclerosing cholangitis

Background: Repeat endoscopic dilatations of dominant strictures (DS) have been reported to be of benefit in patients with primary sclerosing cholangitis (PSC). We aimed to determine the prevalence of DS in patients with PSC and the spontaneous course of ALP and bilirubin, up to a year from diagnosis in patients with and without DS. Method: Cholangiographies from 125 patients with PSC were reevaluated. DS was defined as a stenosis less than or equal to1.5 mm in diameter of the common bile duct (CBD) and/or less than or equal to1.0 mm of right (RHD) or left hepatic duct (LHD). Results: A dominant stricture in common bile duct and/or right hepatic duct or left hepatic duct was present in 56 out of 125 (45%) patients. Mean values for alkaline phosphatase were 16 and 15.2 mukat/L and bilirubin values were 42 and 35 mumol/L before cholangiography in patients with and without DS, respectively (NS). The change in ALP and bilirubin observed from the precholangiographic value up to 2 and 12 months afterward was not significantly different in those with and without DS. Conclusions: Cholestasis in patients with PSC does not seem to be related to the presence of DS. Endoscopic therapy of DS should not be routinely undertaken and randomized studies are needed to clarify its potential benefits.