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Primary sclerosing cholangitis: outcome of patients undergoing restorative proctocolecetomy for ulcerative colitis.
[carcinoma of the gallbladder]
The
prevalence
of
primary
sclerosing
cholangitis
(
PSC
)
among
patients
with
ulcerative
colitis
needing
proctocolectomy
is
about
12
%
.
The
study
aim
was
to
evaluate
the
progression
of
the
liver
disease
after
surgery
.
PSC
progression
in
68
patients
with
UC
after
restorative
proctocolectomy
was
evaluated
after
a
median
follow-up
of
11
years
(
range
0
to
21
)
.
Magnetic
resonance
imaging
(
MRI
)
of
the
liver
,
histological
examination
of
a
core
needle
liver
specimen
,
and
liver
function
tests
were
used
in
addition
to
clinical
history
.
Of
the
68
patients
,
30
participated
in
follow-up
examinations
.
Ductal
changes
in
MRI
suggesting
a
diagnosis
of
PSC
occurred
in
21
(
72
%
)
of
them
.
One
carcinoma
of
the
gallbladder
was
found
in
MRI
.
Histopathologic
changes
suggesting
PSC
were
observable
in
15
(
50
%
)
patients
.
Compared
to
stage
in
peroperative
biopsies
taken
at
proctocolectomy
,
PSC
stage
increased
in
four
(
13
%
)
patients
,
decreased
in
15
(
50
%
)
,
and
remained
unchanged
in
11
(
37
%
)
.
Immunohistochemical
staining
for
cytoceratin-
7
in
hepatocytes
was
positive
in
nine
(
30
%
)
indicating
cholestasis
.
After
IPAA
surgery
,
five
patients
underwent
liver
transplantation
at
1
,
1
,
5
,
6
,
and
11
years
,
respectively
.
Of
the
68
,
six
patients
have
,
to
date
,
developed
cholangiocarcinoma
.
Progression
of
PSC
in
patients
with
minor
ductal
changes
at
the
time
of
restorative
proctocolectomy
is
unlikely
.
Those
patients
with
more
advanced
disease
at
surgery
are
at
risk
for
disease
progression
and
liver
transplantation
.
We
lack
accurate
diagnostic
methods
to
detect
premalignant
changes
of
the
biliary
epithelium
.
Diseases
Validation
Diseases presenting
"advanced disease"
symptom
adrenomyeloneuropathy
carcinoma of the gallbladder
cholangiocarcinoma
coats disease
dedifferentiated liposarcoma
esophageal squamous cell carcinoma
fabry disease
hodgkin lymphoma, classical
primary effusion lymphoma
primary hyperoxaluria type 1
systemic capillary leak syndrome
well-differentiated liposarcoma
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