skip to main content

Primary sclerosing cholangitis with dominant stricture — RCPSC IM MCQ

Instant feedback + full explanation. One question, done properly.

HardGastroenterology/HepatologyPrimary sclerosing cholangitis with dominant strictureRCPSC IM

A patient with primary sclerosing cholangitis develops progressive pruritus, weight loss, bilirubin 72 µmol/L and a new dominant extrahepatic stricture on MRCP. What is the next diagnostic step?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: E — Arrange ERCP with brush cytology and targeted stricture sampling

The best answer is “Arrange ERCP with brush cytology and targeted stricture sampling”. A new dominant stricture with constitutional and cholestatic deterioration raises concern for cholangiocarcinoma and requires endoscopic tissue assessment and biliary management. Medical trials or delayed imaging cannot exclude malignancy, and neither autoimmune-hepatitis treatment nor cholecystectomy addresses the duct lesion.

Reference: Canadian Association of Gastroenterology guideline library and AASLD primary sclerosing cholangitis guidance. https://www.cag-acg.org/clinical-practice-guidelines-and-consensus-reports.html; https://pubmed.ncbi.nlm.nih.gov/36083140/