Is routine cholangiography useful in men with suspected primary biliary cirrhosis?

The aim of this study was to assess the diagnostic value of cholangiography in men with chronic cholestasis and positive antimitochondrial antibody (A MA) titers who were suspected of having primary biliary cirrhosis (PBC). Th e authors reviewed ed retrospectively the records of men who had positive A MA titers over a 16-month period to determine the results of cholangiograph y. They also reviewed the records of 102 patients with primary sclerosing c holangitis (PSC) from 1989 to 1995 who had undergone cholangiography and te sting for AMA. Of 35 men with positive tests for serum AMA, 12 of these pat ients were referred for cholangiography (11 endoscopic and 1 transhepatic). All completed cholangiograms were normal. A diagnosis of PBC was made in n ine patients and atypical autoimmune hepatitis in one. Conversely, only two PSC patients had positive AMA titers (1:20 and 1:80). Both of these patien ts had coexisting inflammatory bowel disease and cholangiograms diagnostic of PSC. Cholangiography was negative in the male patients with positive AMA titers who were suspected of having PBC. In men with cholestatic liver bio chemistries and strongly positive AMA titers, especially in the absence of associated inflammatory bowel disease, routine cholangiography does not add to the diagnostic evaluation.