Clin Endosc.  2014 Nov;47(6):555-559. 10.5946/ce.2014.47.6.555.

IgG4 Levels in Bile for Distinguishing IgG4-Associated Cholangiopathy from Other Biliary Disorders: A Single Blinded Pilot Study

• Navaneethan U
• Gutierrez
• Jegadeesan R
• Venkatesh
• Poptic E
• Sanaka MR
• Vargo JJ
• Parsi MA

• KMID: 2134494
• DOI: http://doi.org/10.5946/ce.2014.47.6.555

Abstract

BACKGROUND/AIMS
Immunoglobulin G4 (IgG4)-associated cholangiopathy (IAC) is an inflammatory disease and may mimic primary sclerosing cholangitis (PSC), cholangiocarcinoma (CCA), or pancreatic cancer on cholangiography. We investigated whether IgG4 levels in bile aspirated during endoscopic retrograde cholangiopancreatography (ERCP) can distinguish IAC from PSC, CCA, and pancreatic cancer.
METHODS
Bile was aspirated directly from the common bile duct during ERCP in patients with IAC prior to steroid therapy. For control purposes, bile was obtained from patients with PSC, CCA, pancreatic cancer, and benign biliary conditions (sphincter of oddi dysfunction/choledocholithiasis).
RESULTS
Biliary IgG4 levels were measured in 54 patients. The median bile IgG4 levels were markedly elevated in patients with IAC (5.5 mg/dL; interquartile range [IQR], 5.1 to 15.6) as compared to patients with benign biliary conditions (0 mg/dL; IQR, 0 to 0.1; p=0.003). The median biliary IgG4 levels in PSC, CCA, and pancreatic cancer were 1.2 (IQR, 0.2 to 3.8), 0.9 (IQR, 0.2 to 3.4), and 0.2 mg/dL (IQR, 0.1 to 0.8), respectively. A cutoff value of 3.8 mg/dL distinguished IAC from PSC and CCA patients with 100% and 76.9% sensitivity and specificity, respectively.
CONCLUSIONS
The results of this pilot study suggest that measurement of biliary IgG4 levels may have clinical value in distinguishing patients with IAC from biliary disorders that can mimic IAC.

Keyword

Cholangiopancreatography, endoscopic retrograde; Immunoglobulin G; Bile

MeSH Terms

Bile*
Cholangiocarcinoma
Cholangiography
Cholangiopancreatography, Endoscopic Retrograde
Cholangitis, Sclerosing
Common Bile Duct
Humans
Immunoglobulin G*
Immunoglobulins
Pancreatic Neoplasms
Pilot Projects*
Sensitivity and Specificity
Immunoglobulin G
Immunoglobulins

Figure

• 

  Fig. 1 IgG4 levels in bile among different study groups. IgG4, immunoglobulin G4; PSC, primary sclerosing cholangitis; CA, carcinoma; IAC, IgG4-associated cholangiopathy.

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