Endoscopic management of PSC, management of Pruritus in PSC
Source: British society / UK-PSC guidelines - 10.1136/gutjnl-2018-317993 ERCP in PSC 1) All patients should receive broad-spectrum antibiotics for 3-5 days 2) Dominant stricture (clinically significant stricture) is defined as a stricture causing functional narrowing - either 1) biochemically (cholestatic LFT), 2) radiologically (upstream dilatation), 3) symptomatically (pruritius). The BSG guideline doesnt mention size criteria for definition of dominant stricture. 3) Obtain cytology from dominant strictures ( sensitivity 50%) every time 4) Balloon dilatation of stricture is thought to retard progression of liver disease by reducing cholestatic injury 5) Stenting is associated with high rates of cholangitis / stent occlusion, as well as pancreatitis. All guidelines recommend against routine stenting in patients with PSC. Dominant stricutre need management with periodic balloon dilatation only without stenting Other things PSC: British guidelines suggest: Annual ultrasound ...