The 17th National Academic Conference on Viral Hepatitis and Liver Diseases of the Chinese Medical Association and the 2015 Annual Meeting of the Infectious Diseases Branch of the Chinese Medical Association and the Hepatology Branch of the Chinese Medical Association were held at the China National Convention Center in Beijing on October 24-25, 2015.
With the theme of “Hepatology in Rapid Development”, the conference focused on the current progress and hot issues of hepatology research, and presented the latest achievements and development trends in the field of hepatology in all aspects. In the morning of 25th, during the invited presentations of other hepatology venues, the Expert Consensus on PSC Diagnosis and Treatment (2015) was promulgated, and the relevant recommendations are summarized as follows.
PSC diagnostic criteria
Recommendation 1: For patients with cholestatic biochemical manifestations, PSC can be diagnosed if biliary imaging has typical manifestations of PSC, and except for those due to other causes.
Recommendation 2: For patients with suspected PSC, biliary imaging should be performed, and MRCP is preferred.
Recommendation 3: Liver biopsy is necessary to diagnose patients with small bile duct PSC without abnormalities on biliary imaging.
Recommendation 4: Liver biopsy is not necessary for the diagnosis of PSC, but can be used to assess disease activity and staging, and can also be used to assist in determining whether other diseases such as AIH overlap.
Differential diagnosis of PSC
Recommendation 5: Anti-mitochondrial antibodies should be tested in patients with suspected PSC to exclude PBC.
Recommendation 6: Patients with suspected PSC should be tested for serum IgG4 at least once to exclude IgG4-associated sclerosing cholangitis.
PSC treatment pharmacotherapy
Recommendation 7: In patients with confirmed PSC, UDCA therapy (C2) may be attempted, but is not recommended based on high-dose UDCA therapy (more than 28 mg/kg/d).
Endoscopic treatment
Recommendation 8: In patients with PSC with significant stricture of the main bile duct, with significant cholestasis and/or with cholangitis as the main symptom, ERCP balloon dilation is feasible for symptomatic relief (C1).
Recommendation 9: Routine stenting is not recommended for PSC patients with significant biliary stenosis, and short-term stenting may be used in patients with severe stenosis (C2).
Percutaneous treatment
Recommendation 10: Patients with PSC with bile duct imaging showing significant stenosis require ERCP cytology and biopsy to rule out bile duct cancer (C1).
Recommendation 11: PSC patients undergoing ERCP need prophylactic antibiotics to reduce the chance of cholangitis (C2).
Liver transplantation recommendation 12: If conditions permit, liver transplantation should be considered as a priority for patients with PSC cirrhosis in the decompensated stage to prolong survival.
Special Conditions
Recommendation 13: For patients with confirmed PSC, colonoscopy with biopsy to assess colitis is recommended; for those with colitis, annual review of colonoscopy is recommended, and for those without manifestations of colitis, review every 3-5 years (C2).
Recommendation 14: Perform imaging and CA199 every 6 months-1 year in patients with PSC to screen for hepatobiliary malignancy (D2).
Summary and outlook
1, the pathogenesis of PSC is still not clear.
2, it is not yet possible to diagnose PSC early before the appearance of biliary strictures on imaging.
3, PSC-specific autoantibodies have not been identified.
4, the efficacy of UDCA needs to be further validated by large-scale clinical trials and long-term follow-up.
5. the modalities and effects of endoscopic treatment still need further determination in more randomized controlled clinical trials.
6, how to prevent recurrence after transplantation has not been resolved.