Prognostic value of cholangiography in primary sclerosing cholangitis.

OBJECTIVE: To examine whether bile duct changes observed on the first diagnostic cholangiograms in patients with primary sclerosing cholangitis (PSC) can predict survival without liver transplantation and survival without symptoms of PSC.

DESIGN: Retrospective study. Findings from the first diagnostic cholangiograms were correlated with the time until the appearance of PSC symptoms and death.

SETTING: Primary and tertiary clinical care hospital.

PATIENTS: Ninety-four patients with a diagnosis of PSC based on cholangiography.

OUTCOME MEASURES: Time to death or liver transplantation and the first appearance of jaundice, upper abdominal pain, pruritus or fever.

RESULTS: Death or liver transplantation, as well as the occurrence of jaundice, were predicted by the grade of intrahepatic duct obstruction; whereas fever, pruritus and abdominal pain were predicted by the grade of extrahepatic duct obstruction.

CONCLUSIONS: High-grade intrahepatic strictures indicate early jaundice and short survival in patients with PSC. High-grade extrahepatic strictures indicate early pruritus, abdominal pain and fever of presumably PSC origin. The grade of intrahepatic strictures should be incorporated into survival models of PSC.