{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,11]],"date-time":"2026-05-11T15:11:53Z","timestamp":1778512313515,"version":"3.51.4"},"reference-count":29,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2019,2,11]],"date-time":"2019-02-11T00:00:00Z","timestamp":1549843200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Digestive Endoscopy"],"published-print":{"date-parts":[[2019,7]]},"abstract":"<jats:sec><jats:title>Background and Aim<\/jats:title><jats:p>Immunoglobulin G4\u2010related sclerosing cholangitis (IgG4\u2010<jats:styled-content style=\"fixed-case\">SC<\/jats:styled-content>) presents as isolated proximal\u2010type sclerosing cholangitis (i\u2010<jats:styled-content style=\"fixed-case\">SC<\/jats:styled-content>). The present study sought\u00a0to clarify the imaging differences between i\u2010<jats:styled-content style=\"fixed-case\">SC<\/jats:styled-content> and Klatskin tumor. Differences between i\u2010<jats:styled-content style=\"fixed-case\">SC<\/jats:styled-content> and IgG4\u2010<jats:styled-content style=\"fixed-case\">SC<\/jats:styled-content> associated with autoimmune pancreatitis (<jats:styled-content style=\"fixed-case\">AIP<\/jats:styled-content>\u2010<jats:styled-content style=\"fixed-case\">SC<\/jats:styled-content>) were also studied.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Differentiating factors between i\u2010<jats:styled-content style=\"fixed-case\">SC<\/jats:styled-content> and Klatskin tumor were studied. Serum IgG4 level, <jats:styled-content style=\"fixed-case\">CA<\/jats:styled-content>19\u20109 level, computed tomography (<jats:styled-content style=\"fixed-case\">CT<\/jats:styled-content>) findings, cholangiography findings (symmetrical smooth long stricture extending into the upper bile duct [<jats:styled-content style=\"fixed-case\">SSLS<\/jats:styled-content>]), endosonographic features (continuous symmetrical mucosal lesion to the hilar part [<jats:styled-content style=\"fixed-case\">CSML<\/jats:styled-content>]), endoscopic biopsy results, treatment, relapse, and survival were also compared between patients with i\u2010<jats:styled-content style=\"fixed-case\">SC<\/jats:styled-content> and those with <jats:styled-content style=\"fixed-case\">AIP<\/jats:styled-content>\u2010<jats:styled-content style=\"fixed-case\">SC<\/jats:styled-content>.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>For a differential diagnosis between i\u2010<jats:styled-content style=\"fixed-case\">SC<\/jats:styled-content> (<jats:italic>N<\/jats:italic>\u00a0=\u00a09) and Klatskin tumor (<jats:italic>N<\/jats:italic>\u00a0=\u00a047), the cut\u2010off value of serum IgG4 level was 150\u00a0mg\/dL (sensitivity, 0.857, specificity, 0.966). Logistic regression analysis indicated that serum IgG4 level, presence of <jats:styled-content style=\"fixed-case\">SSLS<\/jats:styled-content>, presence of <jats:styled-content style=\"fixed-case\">CSML<\/jats:styled-content>, and presence of swollen ampulla are independent factor for identifying i\u2010<jats:styled-content style=\"fixed-case\">SC<\/jats:styled-content>. Relapse rate was significantly higher in the IgG4\u2010<jats:styled-content style=\"fixed-case\">SC<\/jats:styled-content> with <jats:styled-content style=\"fixed-case\">AIP<\/jats:styled-content> group than in the i\u2010<jats:styled-content style=\"fixed-case\">SC<\/jats:styled-content> group (log rank, <jats:italic>P\u00a0<\/jats:italic>=<jats:italic>\u00a0<\/jats:italic>0.046).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Isolated proximal\u2010type sclerosing cholangitis presents as a nodular lesion with <jats:styled-content style=\"fixed-case\">SSLS<\/jats:styled-content> and\/or <jats:styled-content style=\"fixed-case\">CSML<\/jats:styled-content> mimicking a Klatskin tumor. Those endoscopic features might provide a diagnostic clue for i\u2010<jats:styled-content style=\"fixed-case\">SC<\/jats:styled-content>. i\u2010<jats:styled-content style=\"fixed-case\">SC<\/jats:styled-content> is likely to have a more favorable prognosis than IgG4\u2010<jats:styled-content style=\"fixed-case\">SC<\/jats:styled-content> with <jats:styled-content style=\"fixed-case\">AIP<\/jats:styled-content>.<\/jats:p><\/jats:sec>","DOI":"10.1111\/den.13320","type":"journal-article","created":{"date-parts":[[2018,12,20]],"date-time":"2018-12-20T12:04:53Z","timestamp":1545307493000},"page":"422-430","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":16,"title":["Clinical features of isolated proximal\u2010type immunoglobulin G4\u2010related sclerosing cholangitis"],"prefix":"10.1111","volume":"31","author":[{"given":"Yuri","family":"Takagi","sequence":"first","affiliation":[{"name":"Department of Gastroenterology and Hepatology Yokohama City University Graduate School of Medicine Kanagawa Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kensuke","family":"Kubota","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Hepatology Yokohama City University Graduate School of Medicine Kanagawa Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Takuya","family":"Takayanagi","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Hepatology Yokohama City University Graduate School of Medicine Kanagawa Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yusuke","family":"Kurita","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Hepatology Yokohama City University Graduate School of Medicine Kanagawa Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ken","family":"Ishii","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology 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