Role of Endoscopic Procedures in the Diagnosis of IgG4-Related Pancreatobiliary Disease

• Published in: Chonnam medical journal Vol. 57; no. 1; pp. 44 - 50
• Main Authors: Jung, Ye-Ji, Moon, Sung-Hoon, Kim, Myung-Hwan
• Format: Journal Article
• Language: English
• Published: Korea (South) Chonnam National University Medical School 2021; 의과학연구소
• Subjects: Review; 의학일반; IgG4-Related Sclerosing Cholangitis; Autoimmune Pancreatitis; Endoscopy
• ISSN: 2233-7385; 2233-7393
• DOI: 10.4068/cmj.2021.57.1.44

The emergence of the disease entity of glucocorticoid-responsive systemic immunoglobulin G4 (IgG4)-related pancreatobiliary disease has generated substantial attention among the international gastroenterology society. IgG4-related pancreatobiliary disease includes type 1 autoimmune pancreatitis (AIP) and IgG4-related sclerosing cholangitis (IgG4-SC). The typical manifestations of IgG4-related pancreatobiliary disease are cholestatic liver dysfunction, obstructive jaundice, and weight loss, although it may present with no clinical symptoms. Since it mimics tumors on imaging, AIP/IgG4-SC may often be misdiagnosed as pancreatic or biliary cancer. The endoscopic armamentarium for the diagnosis of IgG4-related pancreatobiliary disease includes endoscopic ultrasonography, intraductal ultrasonography, endoscopic retrograde cholangiopancreatography, and cholangioscopy. The role of endoscopic tissue acquisition is two-fold in the diagnosis of IgG4-related pancreatobiliary disease: exclusion of cancer and procurement of histopathological proof for diagnosis of AIP/IgG4-SC, which can also be achieved by adding the immunohistochemistry for IgG4. Our review article addresses the role of various endoscopic examinations in diagnosing IgG4-related pancreatobiliary disease, focusing on the differentiation of this condition from pancreatobiliary malingnancies.