Obstructive jaundice in autoimmune pancreatitis can be safely treated with corticosteroids alone without biliary stenting

• Published in: Pancreatology : official journal of the International Association of Pancreatology (IAP) ... [et al.] Vol. 16; no. 3; pp. 391 - 396
• Main Authors: Bi, Yan, Hart, Phil A., Law, Ryan, Clain, Jonathan E., Farnell, Michael B., Gleeson, Ferga C., Kendrick, Michael L., Levy, Mike J., Pearson, Randall K., Petersen, Bret T., Pisney, Lisa D., Smyrk, Thomas C., Takahashi, Naoki, Topazian, Mark D., Vege, Santhi Swaroop, Chari, Suresh T.
• Format: Journal Article
• Language: English
• Published: Switzerland Elsevier B.V 01.05.2016; Elsevier Limited
• Subjects: Adrenal Cortex Hormones - therapeutic use; Adult; Aged; Aged, 80 and over; Anti-Inflammatory Agents - therapeutic use; Autoimmune Diseases - complications; Autoimmune pancreatitis; Bile; Cholangitis; Chronic pancreatitis; Conflicts of interest; Endocrinology & Metabolism; ERCP (Endoscopic retrograde cholangiopancreatography); Female; Follow-Up Studies; Gastroenterology and Hepatology; Humans; Jaundice, Obstructive - drug therapy; Jaundice, Obstructive - etiology; Liver; Male; Middle Aged; Obstructive jaundice; Pancreatitis, Chronic - complications; Prednisone; Retrospective Studies; Stents; Treatment Outcome; Obstructive jaundice; AST; ALP; Chronic pancreatitis; Cholangitis; AIP; ALT; Prednisone; ERCP; Autoimmune pancreatitis; ERCP (Endoscopic retrograde cholangiopancreatography); TB; Endoscopic retrograde cholangiopancreatography; total bilirubin; alanine aminotransferase; aspartate aminotransferase; alkaline phosphatase
• ISSN: 1424-3903; 1424-3911; 1424-3911
• DOI: 10.1016/j.pan.2016.03.017

Autoimmune pancreatitis (AIP) responds dramatically to corticosteroids treatment. We reviewed our experience to determine the safety and effectiveness of treating obstructive jaundice in definitive AIP with corticosteroids alone without biliary stenting. From our AIP database, we retrospectively identified type 1 AIP subjects whose jaundice was treated with corticosteroids alone without biliary stenting. Their medical records were reviewed and clinical data were evaluated to determine the outcomes. Fifteen AIP subjects (87% male, mean age 68.4 years) were treated with corticosteroids at initial presentation (n = 8), first (n = 5) or subsequent (n = 2) relapse. Mean values (upper limit of normal, ULN) of liver tests prior to corticosteroids were aspartate aminotransferase (AST) 203.5u/l (4 × ULN), alanine aminotransferase (ALT) 325.8u/l (6 × ULN), alkaline phosphatase (ALP) 567.4u/l (5 × ULN), and total bilirubin (TB) 5.9 mg/dl (5.9 × ULN). At first follow-up (mean 4 days) the decrease was 54.9% for AST, 51.6% for ALT, 33% for ALP and 47.2% for TB (all p < 0.05). After 15–45 days, all patients had normal AST, 3/15 had ALT > 1.5 × ULN, 1/15 had ALP > 1.5 × ULN, 1/15 had TB > 1.5 × ULN. No patient required biliary stent placement, or developed cholangitis or other infectious complications during steroid treatment. Under the supervision of an experienced pancreatologist and with close monitoring of patients, obstructive jaundice secondary to definitive AIP can be safely and effectively managed with corticosteroids alone, without the need for biliary stenting.