Evaluation of a modified cholangiographic classification system for primary sclerosing cholangitis

Background: There is no uniformly accepted classification system for the ra nge of cholangiographic abnormalities encountered in primary sclerosing cho langitis (PSC). The aims of this study were to evaluate a previously develo ped classification system and to test the hypothesis that the pancreatic du ct can be involved in PSC. Methods: Two observers scored 132 endoscopic retrograde cholangiopancreatog raphies (ERCPs) from established PSC patients. From 30 patients, subsequent ERCPs were scored and compared with the initial ERCPs. The pancreatic duct was judged with regard to morphologic abnormalities. Results: The classification system was applicable in 107 patients. In 10 ER CPs (7.6%), no clear intrahepatic abnormalities were found; 15 other ERCPs (11.4%) did not show extrahepatic abnormalities. In 30 cases, a subsequent ERCP was judged. The difference in scoring between the initial and the subs equent ERCPs was statistically significant, with the subsequent ERCP having higher intrahepatic and extrahepatic scores. Sixty-four adequately filled pancreatic ducts were analyzed. In two cases (3.1%), morphologic abnormalit ies were found. Conclusions: The previously developed scoring system is very applicable for almost all PSC patients when supplemented with a type 0 category. Scoring increased over time, suggesting a correlation with disease severity. The pa ncreatic duct does not seem to be involved in PSC.