Predictors of successful clinical, radiological and laboratory outcomes in patients with primary sclerosing cholangitis (PSC) undergoing ERCP

ERCP is commonly performed in patients with known PSC in hopes of delineating dominant strictures amenable to endoscopic therapy. Knowledge of certain factors may be important in predicting successful management of these patients. Objective: To determine which factors are predictive for laboratory, radiological and clinical success in PSC. Methods: All patients with PSC who underwent ERCP at our medical center between 1987 and 1997 were identified using a commercially available database. Clinical success was defined as resolution of presenting symptoms. Radiological success was defined as improvement of the chloangiogram. Laboratory success was denned as improvement in 2 of 3 liver enzymes (AST, ALT and alkaline phosphate) by 50% or resolution of jaundice. Using univariate and multivariate logistic regression radiological, laboratory and clinical success were used as the outcome variables while age, race, gender, duration of disease and symptoms, presence of IBD, location, and nature of the stricture and therapy were tested as candidate predictor variables. Results: 104 patients who underwent 204 procedures of which 56 ERCPs were diagnostic. In the univariate analysis, the presence of a dominant stricture, especially of the common bile duct (CBD), and therapeutic intervention were the only predictors of clinical, radiological and laboratory improvement. Patients with CBD strictures were 2.47 times (CI95 1.27-4.81) more likely to have a successful clinical outcome and 2.03 times (CI95 1.07-3.87) more likely to have laboratory improvement than if the stricture was elsewhere. Therapeutic endoscopic therapy of all types was 4.23 times (CI95 2.15-8.34) more likely to result in clinical improvement and 1.99 times (CI95 1.01-3.94) more likely to have laboratory improvement than diagnostic ERCP. In a multivariate logistic regression, bilirubin and endoscopic therapy were predictive of a successful clinical outcome (p=0.0001). Alkaline phosphatase and the presence of a dominant stricture were predictive of a successful laboratory outcome (p=0.0001). Conclusions: 1) The presence of CBD strictures, a dominant stricture and a therapeutic ERCP are independently predictive of positive clinical, radiological and laboratory improvement. 2) The higher the bilirubin, the less likely that a successful clinical outcome will occur. 3) The higher the alkaline phosphatase, the more likely that laboratory success will occur. 4) Age, gender, duration of disease, type and duration of symptoms, presenting transaminases and the presence of IBD are not predictive of successful outcomes in patients with PSC who undergo ERCP.

Duke Scholars

Author Malcolm Stanley Branch Medicine, Gastroenterology

Author Paul Simon Jowell Medicine, Gastroenterology