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Pancreatographic findings such as a long narrowing of the main pancreatic duct, lack of upstream dilatation, skipped narrowed lesions, and side branches arising from the narrowed portion suggest <jats:styled-content style=\"fixed-case\">AIP<\/jats:styled-content> rather than pancreatic carcinoma. Cholangiographic findings for <jats:styled-content style=\"fixed-case\">PSC<\/jats:styled-content>, including band\u2010like stricture, beaded or pruned\u2010tree appearance, or diverticulum\u2010like outpouching are rarely observed in <jats:styled-content style=\"fixed-case\">IgG<\/jats:styled-content>4\u2010<jats:styled-content style=\"fixed-case\">SC<\/jats:styled-content> patients, whereas dilatation after a long stricture of the bile duct is common in <jats:styled-content style=\"fixed-case\">IgG<\/jats:styled-content>4\u2010<jats:styled-content style=\"fixed-case\">SC<\/jats:styled-content>. Transpapillary biopsy for bile duct stricture is useful to rule out cholangiocarcinoma and to support the diagnosis of <jats:styled-content style=\"fixed-case\">IgG<\/jats:styled-content>4\u2010<jats:styled-content style=\"fixed-case\">SC<\/jats:styled-content> with <jats:styled-content style=\"fixed-case\">IgG<\/jats:styled-content>4\u2010immunostaining. <jats:styled-content style=\"fixed-case\">IgG<\/jats:styled-content>4\u2010immunostaining of biopsy specimens from the major papilla advances a diagnosis of <jats:styled-content style=\"fixed-case\">AIP<\/jats:styled-content>. Contrast\u2010enhanced endoscopic ultrasonography (<jats:styled-content style=\"fixed-case\">EUS<\/jats:styled-content>) and <jats:styled-content style=\"fixed-case\">EUS<\/jats:styled-content> elastography have the potential to predict the histological nature of the lesions. Intraductal ultrasonographic finding of wall thickening in the non\u2010stenotic bile duct on cholangiography is useful for distinguishing <jats:styled-content style=\"fixed-case\">IgG<\/jats:styled-content>4\u2010<jats:styled-content style=\"fixed-case\">SC<\/jats:styled-content> from cholangiocarcinoma. Endoscopic ultrasound\u2010guided fine\u2010needle aspiration (<jats:styled-content style=\"fixed-case\">EUS\u2010FNA<\/jats:styled-content>) is widely used to exclude pancreatic carcinoma. To obtain adequate tissue samples for the histological diagnosis of <jats:styled-content style=\"fixed-case\">AIP<\/jats:styled-content>, <jats:styled-content style=\"fixed-case\">EUS<\/jats:styled-content>\u2010<jats:styled-content style=\"fixed-case\">T<\/jats:styled-content>ru\u2010cut biopsy or <jats:styled-content style=\"fixed-case\">EUS<\/jats:styled-content>\u2010<jats:styled-content style=\"fixed-case\">FNA<\/jats:styled-content> using a 19\u2010gauge needle is recommended, but <jats:styled-content style=\"fixed-case\">EUS<\/jats:styled-content>\u2010<jats:styled-content style=\"fixed-case\">FNA<\/jats:styled-content> with a 22\u2010gauge needle can also provide sufficient histological samples with careful sample processing after collection and rapid motion of the <jats:styled-content style=\"fixed-case\">FNA<\/jats:styled-content> needles within the pancreas. Validation of endoscopic imaging criteria and new techniques or devices to increase the diagnostic yield of endoscopic tissue sampling should be developed.<\/jats:p>","DOI":"10.1111\/den.12289","type":"journal-article","created":{"date-parts":[[2014,4,9]],"date-time":"2014-04-09T01:37:03Z","timestamp":1397007423000},"page":"627-635","source":"Crossref","is-referenced-by-count":38,"title":["Role of endoscopy in the diagnosis of autoimmune pancreatitis and immunoglobulin <scp>G<\/scp>4\u2010related sclerosing cholangitis"],"prefix":"10.1111","volume":"26","author":[{"given":"Terumi","family":"Kamisawa","sequence":"first","affiliation":[{"name":"Department of Internal Medicine Tokyo Metropolitan Komagome Hospital  Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hirotaka","family":"Ohara","sequence":"additional","affiliation":[{"name":"Department of Community\u2010Based Medical Education Nagoya City University Graduate School of Medical Sciences  Nagoya 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