In people with primary sclerosing cholangitis (PSC), chronic inflammation of the bile ducts leads to progressive injury. Scarring and thickening of tissue in the ducts can narrow the canal through which bile flows, leading to cirrhosis and liver damage. Some people with PSC have an elevated risk of bile duct cancer (cholangiocarcinoma). At NewYork-Presbyterian, we offer advanced interventional endoscopic techniques to open blocked bile ducts—techniques which are not widely available elsewhere to relieve pain and other symptoms, improve liver function, and enhance your quality of life.
A Team of Cholangitis Experts
NewYork-Presbyterian's digestive disease team includes a number of specialists with extensive experience treating PSC, including hepatologists (liver doctors), gastroenterologists, interventional endoscopists, surgeons, and others. These physicians work with you to slow the progression of PSC and preserve your liver function for as long as possible. You may also be at risk of nutritional deficiencies, such as vitamins A, C, and D, and calcium. A registered dietitian can work with you to ensure you are getting enough of these and other vital nutrients.
An Accurate Diagnosis
The symptoms of PSC may be due to other disorders, so an accurate diagnosis is essential to ensure you receive the most effective care. At NewYork-Presbyterian, we use the following tests to determine if you have PSC, including advanced techniques that not all hospitals offer.
- Imaging tests. CT scanning and magnetic resonance imaging (MRI).
- Endoscopic ultrasound (EUS). The use of a special endoscope with high-energy sound waves ("echoendoscope") to see your digestive tract and nearby organs.
- Probe-based confocal endomicroscopy. NewYork-Presbyterian is one of few hospitals offering this highly specialized approach, which involves the use of a small microscope to evaluate narrowing in your bile ducts.
- Narrow band imaging. With this endoscopic technique, our doctors use a special system to capture high-resolution images of your bile ducts without the use of dyes. NBI relies on the fact that light of different wavelengths penetrates tissue at different depths, and can be used to see fine features of the lining (mucosa) of your bile ducts.
- Magnetic resonance cholangiopancreatography (MRCP). MRI is used to produce detailed cross-sectional images of your digestive organs and tissues.
- Liver biopsy. The physician takes a small sample of liver tissue to examine it for cirrhosis and other damage.
- ERCP (endoscopic retrograde cholangiopancreatography) using the Spyglass® direct visualization system. An interventional endoscopist guides an endoscope through your mouth to the bile ducts, releases a dye that assists in imaging, and then x-rays them. If necessary, a smaller scope can be utilized to view the bile ducts directly and to assist in providing biopsies. Bile duct tissue can be analyzed to determine if a patient is at a higher risk of developing cancer. NewYork-Presbyterian’s interventional endoscopists routinely perform this procedure and are highly regarded experts in its use.
Comprehensive Treatment for Primary Sclerosing Cholangitis
There is no cure for PSC, but there are steps our doctors take to relieve your symptoms.
- Medications. For early PSC, doctors may prescribe the drug cholestyramine (Questran) to relieve itching, which works by reducing the level of bile acids in your blood and skin. You may also receive low doses of ursodeoxycholic acid (UDCA), a naturally occurring bile acid, to increase the flow of bile and reduce inflammation of the bile ducts in early stages of the disease.
- ERCP. An interventional endoscopist can insert a miniature balloon and stent (tiny tube) within a narrowed area to re-open a blocked or clogged bile duct, restore function, and reduce your symptoms.
- Therapy of ulcerative colitis. Many patients with PSC also have ulcerative colitis, a chronic disease that may induce injury of the colon. Our team of expert gastroenterologists provides cutting edge therapy for this condition.
Liver Transplantation for Primary Sclerosis Cholangitis
If you have advanced PSC, a liver transplant may help prolong your life. At NewYork-Presbyterian, you are ten times more likely to receive a liver transplant than at other hospitals in the region, with an average wait time of just nine months. Our surgeons have performed more than 2,000 liver transplants, with outcomes that meet or surpass national averages. They use a variety of liver transplant approaches, including living donor liver transplantation, to extend the limits of organ transplantation and provide the greatest number of transplants possible.
Clinical Trials for PSC
Our researchers are evaluating new therapies for primary sclerosing cholangitis and its complications that show promise for being more effective than standard treatments. Your care team will let you know if you are eligible to participate in a clinical trial of an innovative therapy.