Endoscopy 2017; 49(06): 588-608
DOI: 10.1055/s-0043-107029
© Georg Thieme Verlag KG Stuttgart · New York

Role of endoscopy in primary sclerosing cholangitis: European Society of Gastrointestinal Endoscopy (ESGE) and European Association for the Study of the Liver (EASL) Clinical Guideline

Lars Aabakken1, Tom H. Karlsen2, Jörg Albert3, Marianna Arvanitakis4, Olivier Chazouilleres5, Jean-Marc Dumonceau6, Martti Färkkilä7, Peter Fickert8, Gideon M. Hirschfield9, Andrea Laghi10, Marco Marzioni11, Michael Fernandez4, Stephen P. Pereira12, Jürgen Pohl13, Jan-Werner Poley14, Cyriel Y. Ponsioen15, Christoph Schramm16, Fredrik Swahn17, Andrea Tringali18, Cesare Hassan19
  • 1GI Endoscopy, Rikshospitalet University Hospital, Hospital, and Faculty of Medicine, University of Oslo,Oslo, Norway
  • 2Norwegian PSC Research Center and Section for Gastroenterology, Department of Transplantation Medicine, Division of Cancer Medicine, Surgery and Transplantation, Oslo University Hospital, Rikshospitalet, and Institute of Clinical Medicine, University of Oslo, Oslo, Norway
  • 3Abteilung für Gastroenterologie, Hepatologie und Endokrinologie, Robert-Bosch-Krankenhaus, Stuttgart, Germany
  • 4Department of Gastroenterology, Hepatopancreatology and Digestive Oncology, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium
  • 5Service d’Hépatologie, Hôpital Saint-Antoine, Assistance Publique – Hôpitaux de Paris, Centre de référence des maladies inflammatoires du foie et des voies biliaires, Filière Maladies Rares du Foie de l’Adulte et de l’Enfant (FILFOIE), UPMC UNIV Paris 06, France
  • 6Gedyt Endoscopy Center, Buenos Aires, Argentina
  • 7Department of Gastroenterology, Helsinki University Central Hospital, Helsinki, Finland
  • 8Research Unit for Experimental and Molecular Hepatology, Division of Gastroenterology and Hepatology, Department of Internal Medicine, Medical University of Graz, Austria
  • 9National Institute for Health Research (NIHR), Birmingham Liver Biomedical Research Unit (BRU), and Centre for Liver Research, University of Birmingham, Birmingham, United Kingdom
  • 10Pathological Sciences, Sapienza-University, Rome, Italy
  • 11Clinic of Gastroenterology and Hepatology, Università Politecnica delle Marche – Ospedali Riuniti University Hospital, Ancona, Italy
  • 12Institute for Liver and Digestive Health, University College London, Royal Free Campus, London, UK
  • 13Department of Gastroenterology and Interventional Endoscopy, Klinikum Friedrichshain, Berlin, Germany
  • 14Department of Gastroenterology and Hepatology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
  • 15Department of Gastroenterology and Hepatology, Academic Medical Center, Amsterdam, The Netherlands
  • 16Department of Medicine I and Martin Zeitz Centre for Rare Diseases, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
  • 17Center for Digestive Diseases, Karolinska University Hospital and Division of Surgery, CLINTEC, Karolinska Institute, Stockholm, Sweden
  • 18Digestive Endoscopy Unit, Catholic University, Rome, Italy
  • 19Digestive Endoscopy Unit, Nuovo Regina Margherita Hospital, Rome, Italy
Further Information

Publication History

Publication Date:
18 April 2017 (eFirst)


1 ESGE/EASL recommend that, as the primary diagnostic modality for PSC, magnetic resonance cholangiography (MRC) should be preferred over endoscopic retrograde cholangiopancreatography (ERCP).

Moderate quality evidence, strong recommendation.

2 ESGE/EASL suggest that ERCP can be considered if MRC plus liver biopsy is equivocal or contraindicated in patients with persisting clinical suspicion of PSC. The risks of ERCP have to be weighed against the potential benefit with regard to surveillance and treatment recommendations.

Low quality evidence, weak recommendation.

6 ESGE/EASL suggest that, in patients with an established diagnosis of PSC, MRC should be considered before therapeutic ERCP.

Weak recommendation, low quality evidence.

7 ESGE/EASL suggest performing endoscopic treatment with concomitant ductal sampling (brush cytology, endobiliary biopsies) of suspected significant strictures identified at MRC in PSC patients who present with symptoms likely to improve following endoscopic treatment.

Strong recommendation, low quality evidence.

9 ESGE/EASL recommend weighing the anticipated benefits of biliary papillotomy/sphincterotomy against its risks on a case-by-case basis.

Strong recommendation, moderate quality evidence.

Biliary papillotomy/sphincterotomy should be considered especially after difficult cannulation.

Strong recommendation, low quality evidence.

16 ESGE/EASL suggest routine administration of prophylactic antibiotics before ERCP in patients with PSC.

Strong recommendation, low quality evidence.

17 EASL/ESGE recommend that cholangiocarcinoma (CCA) should be suspected in any patient with worsening cholestasis, weight loss, raised serum CA19-9, and/or new or progressive dominant stricture, particularly with an associated enhancing mass lesion.

Strong recommendation, moderate quality evidence.

19 ESGE/EASL recommend ductal sampling (brush cytology, endobiliary biopsies) as part of the initial investigation for the diagnosis and staging of suspected CCA in patients with PSC.

Strong recommendation, high quality evidence.