Value of liver biopsy and endoscopic retrograde cholangiography in patients with chronic anicteric cholestasis: a retrospective study of 79 patients.

Aim.-To determine the diagnostic value of systematic liver needle biopsy an d endoscopic retrograde cholangiography in patients with unexplained chroni c anicteric cholestasis. Methods.-Seventy nine patients presented with anicteric cholestasis for ove r 6 months as defined by : a concomitant increase in at least 2 of 3 choles tatic enzymes (GGT, alkaline phosphatase, 5' nucleotidase); a low cytolytic ratio (ALT/AP (xN/xN) less than or equal to 5); and negative test results (normal ultrasound scan; no antimitochondrial antibodies, viral, drug-induc ed, or toxic hepatitis or known ulcerative cholitis). Based on liver biopsy and endoscopic retrograde cholangiography, 5 groups were determined; group A: normal liver biopsy and endoscopic retrograde cholangiography; group B: primary sclerosing cholangitis with histological biliary lesions; group C: primary sclerosing cholangitis with normal histology; group D: histologic biliary lesions alone; group E: other (aspecific histologic lesions, isolat ed anomalies of intrahepatic bile ducts on endoscopic retrograde cholangiog raphy). Results.-Diagnosis of cholestasis was fortuitous in 43% of cases. Group A: 5 patients had normal liver biopsy and endoscopic retrograde cholangiograph y: group B (10 patients): 5 with destructive cholangitis, 5 with degenerati ve cholangitis, associated with portal fibrosis in 90%; group C : none of t he patients had primary sclerosing cholangitis with normal histology; group D: 39 patients {idiopathic ductopenia (1), Caroli's disease (1), benign re current cholestasis (1), regenerative nodular hyperplasia (4), destructive cholangitis without ductopenia (7), degenerative cholangitis (15), ductular proliferation (10)}; group E : 24 patients with aspecific histologic lesio ns, and one patient with isolated anomalies of the intrahepatic vile ducts on endoscopic retrograde cholangiography. Conclusions.-Int he present population: a) 13% presented with intense chola ngitis and primary sclerosing cholangitis on endoscopic retrograde cholangi ography; b) 49% presented with various histologic biliary lesions without p rimary sclerosing cholangitis. We conclude that in chronic anicteric choles tasis of unexplained origin, first choice work-up should include liver biop sy, and endoscopic retrograde cholangiography should only be performed when intense histologic cholangitis is observed.