{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,7]],"date-time":"2026-07-07T22:45:32Z","timestamp":1783464332037,"version":"3.55.0"},"reference-count":31,"publisher":"MDPI AG","issue":"15","license":[{"start":{"date-parts":[[2024,7,26]],"date-time":"2024-07-26T00:00:00Z","timestamp":1721952000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>Background\/Purpose: Differential diagnosis of isolated immunoglobin (Ig)G4-related sclerosing cholangitis (IgG4-SC) and cholangiocarcinoma is challenging. We aimed to clarify the role of endoscopic retrograde cholangiography (ERCP)-related procedures in the differential diagnosis of isolated IgG4-SC and perihilar cholangiocarcinoma (PHCC). Methods: Seven patients with hilar-type isolated IgG4-SC diagnosed at Hiroshima University Hospital and sixty-five patients with surgically resected invasive PHCC were enrolled, and the diagnostic yields of intraductal ultrasonography (IDUS), peroral cholangioscopy (POCS), and pathological examinations were determined. Results: In six of seven (86%) patients with isolated IgG4-SC, the stricture was in the perihilar bile duct. IDUS showed that symmetrical wall thickening (40% vs. 5%, p = 0.04), homogeneous internal echo (80% vs. 5%, p &lt; 0.001), and smooth outer margins (80% vs. 6%, p &lt; 0.001) were more frequent in isolated IgG4-SC than in PHCC. POCS showed a smooth mucosal surface more frequent in isolated IgG4-SC (75% vs. 7%, p = 0.006). Only one patient had two pathological findings characteristic of IgG4-SC. The sensitivity for diagnosing PHCC was 81% using two or more combined sampling methods. Conclusions: Pathological examinations have limitations in the differential diagnosis of isolated-IgG4-SC and PHCC, and a diagnostic strategy that combines multiple ERCP-related procedures, including IDUS and POCS, is recommended.<\/jats:p>","DOI":"10.3390\/diagnostics14151621","type":"journal-article","created":{"date-parts":[[2024,7,26]],"date-time":"2024-07-26T14:39:08Z","timestamp":1722004748000},"page":"1621","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Endoscopic Retrograde Cholangiopancreatography-Related Procedures for the Differential Diagnosis of Isolated Immunoglobin G4-Related Sclerosing Cholangitis and Perihilar Cholangiocarcinoma"],"prefix":"10.3390","volume":"14","author":[{"given":"Masaru","family":"Furukawa","sequence":"first","affiliation":[{"name":"Department of Gastroenterology, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima 734-8551, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3545-8743","authenticated-orcid":false,"given":"Yasutaka","family":"Ishii","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima 734-8551, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yumiko","family":"Tatsukawa","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima 734-8551, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3263-7271","authenticated-orcid":false,"given":"Shinya","family":"Nakamura","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima 734-8551, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3992-0472","authenticated-orcid":false,"given":"Juri","family":"Ikemoto","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima 734-8551, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sayaka","family":"Miyamoto","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima 734-8551, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kazuki","family":"Nakamura","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima 734-8551, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yumiko","family":"Yamashita","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima 734-8551, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Noriaki","family":"Iijima","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima 734-8551, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yasuhiro","family":"Okuda","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima 734-8551, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Risa","family":"Nomura","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima 734-8551, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Koji","family":"Arihiro","sequence":"additional","affiliation":[{"name":"Department of Anatomical Pathology, Hiroshima University Hospital, Hiroshima 734-0037, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3196-8551","authenticated-orcid":false,"given":"Keiji","family":"Hanada","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Onomichi General Hospital, Hiroshima 722-0018, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shiro","family":"Oka","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima 734-8551, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2024,7,26]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1460","DOI":"10.1016\/S0140-6736(14)60720-0","article-title":"IgG4-related disease","volume":"385","author":"Kamisawa","year":"2015","journal-title":"Lancet"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"79","DOI":"10.1007\/s00535-011-0465-z","article-title":"Diagnostic criteria for IgG4-related sclerosing cholangitis based on cholangiographic classification","volume":"47","author":"Nakazawa","year":"2012","journal-title":"J. Gastroenterol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"683","DOI":"10.1136\/gut.52.5.683","article-title":"Close relationship between autoimmune pancreatitis and multifocal fibrosclerosis","volume":"52","author":"Kamisawa","year":"2003","journal-title":"Gut"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1722","DOI":"10.1016\/j.humpath.2014.04.006","article-title":"Isolated IgG4-related sclerosing cholangitis: A report of 9 cases","volume":"45","author":"Graham","year":"2014","journal-title":"Hum. Pathol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1308","DOI":"10.1016\/j.dld.2021.02.009","article-title":"Clinical characteristics of immunoglobulin IgG4-related sclerosing cholangitis: Comparison of cases with and without autoimmune pancreatitis in a large cohort","volume":"53","author":"Naitoh","year":"2021","journal-title":"Dig. Liver Dis."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"229","DOI":"10.1097\/01.mpa.0000202941.85955.07","article-title":"Schematic classification of sclerosing cholangitis with autoimmune pancreatitis by cholangiography","volume":"32","author":"Nakazawa","year":"2006","journal-title":"Pancreas"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1247","DOI":"10.1111\/jgh.12248","article-title":"Establishment of a serum IgG4 cut-off value for the differential diagnosis of IgG4-related sclerosing cholangitis: A Japanese cohort","volume":"28","author":"Ohara","year":"2013","journal-title":"J. Gastroenterol. Hepatol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"43","DOI":"10.1002\/jhbp.50","article-title":"Nationwide survey for primary sclerosing cholangitis and IgG4-related sclerosing cholangitis in Japan","volume":"21","author":"Tanaka","year":"2014","journal-title":"J. Hepatobiliary Pancreat. Sci."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"315","DOI":"10.1007\/s12664-016-0672-x","article-title":"IgG4-associated sclerosing cholangitis masquerading as hilar cholangiocarcinoma","volume":"35","author":"Yadav","year":"2016","journal-title":"Indian J. Gastroenterol."},{"key":"ref_10","first-page":"594","article-title":"IgG4-related sclerosing cholangitis: Not always an obvious entity","volume":"34","author":"Velegraki","year":"2021","journal-title":"Ann. Gastroenterol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"4953","DOI":"10.1016\/j.asjsur.2023.06.005","article-title":"Resection of isolated bile duct dilatation in immunoglobulin G4 hepatobiliary disease mimicking cholangiocarcinoma","volume":"46","author":"Liao","year":"2023","journal-title":"Asian J. Surg."},{"key":"ref_12","doi-asserted-by":"crossref","unstructured":"Boicean, A., Birlutiu, V., Ichim, C., Todor, S.B., Hasegan, A., Bacila, C., Solomon, A., Cristian, A., and Dura, H. (2023). Predictors of Post-ERCP Pancreatitis (P.E.P.) in Choledochal Lithiasis Extraction. J. Pers. Med., 13.","DOI":"10.3390\/jpm13091356"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"520","DOI":"10.1016\/S0016-5107(95)70004-8","article-title":"Endoscopic retrograde forceps biopsy and brush cytology of biliary strictures: A prospective study","volume":"42","author":"Pugliese","year":"1995","journal-title":"Gastrointest. Endosc."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"565","DOI":"10.1016\/S0016-5107(95)70012-9","article-title":"Value of endobiliary brush cytology and biopsies for the diagnosis of malignant bile duct stenosis: Results of a prospective study","volume":"42","author":"Ponchon","year":"1995","journal-title":"Gastrointest. Endosc."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"383","DOI":"10.1016\/S0016-5107(00)70435-4","article-title":"Triple-tissue sampling at ERCP in malignant biliary obstruction","volume":"51","author":"Jailwala","year":"2000","journal-title":"Gastrointest. Endosc."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"1615","DOI":"10.1111\/j.1440-1746.2007.05037.x","article-title":"Usefulness of transpapillary bile duct brushing cytology and forceps biopsy for improved diagnosis in patients with biliary strictures","volume":"22","author":"Kitajima","year":"2007","journal-title":"J. Gastroenterol. Hepatol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1097","DOI":"10.3748\/wjg.14.1097","article-title":"Endoscopic transpapillary brush cytology and forceps biopsy in patients with hilar cholangiocarcinoma","volume":"14","author":"Weber","year":"2008","journal-title":"World J. Gastroenterol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"623","DOI":"10.1007\/s002610000208","article-title":"Utility and limitations of intraductal ultrasonography in distinguishing longitudinal cancer extension along the bile duct from inflammatory wall thickening","volume":"26","author":"Tamada","year":"2001","journal-title":"Abdom. Imaging"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1147","DOI":"10.1007\/s00535-009-0108-9","article-title":"Endoscopic transpapillary intraductal ultrasonography and biopsy in the diagnosis of IgG4-related sclerosing cholangitis","volume":"44","author":"Naitoh","year":"2009","journal-title":"J. Gastroenterol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"630","DOI":"10.1067\/mge.2000.108667","article-title":"Cholangioscopic findings in bile duct tumors","volume":"52","author":"Seo","year":"2000","journal-title":"Gastrointest. Endosc."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"635","DOI":"10.1067\/mge.2000.108969","article-title":"Tumor vessel: A valuable cholangioscopic clue of malignant biliary stricture","volume":"52","author":"Kim","year":"2000","journal-title":"Gastrointest. Endosc."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"374","DOI":"10.1016\/j.gie.2005.04.032","article-title":"Diagnostic utility of peroral cholangioscopy for various bile-duct lesions","volume":"62","author":"Fukuda","year":"2005","journal-title":"Gastrointest. Endosc."},{"key":"ref_23","doi-asserted-by":"crossref","unstructured":"Ishii, Y., Serikawa, M., Tsuboi, T., Kawamura, R., Tsushima, K., Nakamura, S., Hirano, T., Fukiage, A., Ikemoto, J., and Kiyoshita, Y. (2020). Usefulness of peroral cholangioscopy in the differential diagnosis of IgG4-related sclerosing cholangitis and extrahepatic cholangiocarcinoma: A single-center retrospective study. BMC Gastroenterol., 20.","DOI":"10.1186\/s12876-020-01429-2"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"934","DOI":"10.1016\/j.cgh.2010.06.029","article-title":"Diagnostic peroral video cholangioscopy is an accurate diagnostic tool for patients with bile duct lesions","volume":"8","author":"Itoi","year":"2010","journal-title":"Clin. Gastroenterol. Hepatol."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"181","DOI":"10.1002\/jhbp.211","article-title":"Classification of biliary tract cancers established by the Japanese Society of Hepato-Biliary-Pancreatic Surgery: 3(rd) English edition","volume":"22","author":"Miyazaki","year":"2015","journal-title":"J. Hepatobiliary Pancreat. Sci."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"235","DOI":"10.1002\/jhbp.913","article-title":"Clinical diagnostic criteria for IgG4-related sclerosing cholangitis 2020: (Revision of the clinical diagnostic criteria for IgG4-related sclerosing cholangitis 2012)","volume":"28","author":"Nakazawa","year":"2021","journal-title":"J. Hepatobiliary Pancreat. Sci."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"1334","DOI":"10.3748\/wjg.v21.i4.1334","article-title":"Isolated intrapancreatic IgG4-related sclerosing cholangitis","volume":"21","author":"Nakazawa","year":"2015","journal-title":"World J. Gastroenterol."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"535","DOI":"10.1016\/j.mayocpiqo.2021.03.005","article-title":"Diagnosing Biliary Strictures: Distinguishing IgG4-Related Sclerosing Cholangitis from Cholangiocarcinoma and Primary Sclerosing Cholangitis","volume":"5","author":"Hori","year":"2021","journal-title":"Mayo Clin. Proc. Innov. Qual. Outcomes"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"422","DOI":"10.1111\/den.13320","article-title":"Clinical features of isolated proximal-type immunoglobulin G4-related sclerosing cholangitis","volume":"31","author":"Takagi","year":"2019","journal-title":"Dig. Endosc."},{"key":"ref_30","doi-asserted-by":"crossref","unstructured":"Minami, H., Mukai, S., Sofuni, A., Tsuchiya, T., Ishii, K., Tanaka, R., Tonozuka, R., Honjo, M., Yamamoto, K., and Nagai, K. (2021). Clinical Outcomes of Digital Cholangioscopy-Guided Procedures for the Diagnosis of Biliary Strictures and Treatment of Difficult Bile Duct Stones: A Single-Center Large Cohort Study. J. Clin. Med., 10.","DOI":"10.3390\/jcm10081638"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"9","DOI":"10.1002\/jhbp.596","article-title":"Clinical practice guidelines for IgG4-related sclerosing cholangitis","volume":"26","author":"Kamisawa","year":"2019","journal-title":"J. Hepatobiliary Pancreat. Sci."}],"container-title":["Diagnostics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-4418\/14\/15\/1621\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T15:24:41Z","timestamp":1760109881000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-4418\/14\/15\/1621"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,7,26]]},"references-count":31,"journal-issue":{"issue":"15","published-online":{"date-parts":[[2024,8]]}},"alternative-id":["diagnostics14151621"],"URL":"https:\/\/doi.org\/10.3390\/diagnostics14151621","relation":{},"ISSN":["2075-4418"],"issn-type":[{"value":"2075-4418","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,7,26]]}}}