Surgery for sclerosing cholangitis.

The diagnosis of primary sclerosing cholangitis is made radiologically in patients with extrahepatic obstructive jaundice. This condition lacks a known cause and another method of diagnosis, and its treatment is palliative-mechanical, with bypasses, dilation, or orthotopic liver transplantation. Recent progress has been seen in stratifying patients with respect to prognosis. Stratification is important for conducting clinical trials and for predicting which patients should receive a transplant at an earlier, less risky stage in the course of the disease. Expandable metal stents are on trial in patients with benign or malignant strictures. These newer stents seem to be better than polyethylene stents, although their use has not been reported in sclerosing cholangitis. With survival data used as a measuring point, relief of jaundice does not appear to correlate with increased survival. Of concern has been the association of cholangiocarcinoma with sclerosing cholangitis. Cholangiocarcinoma is difficult to recognize clinically and has a negative impact on the results of transplantation.