Primary Sclerosing Cholangitis: When ERCP with Balloon Dilatation Has Not Resolved Pruritus or Cholangitis

This protocol applies to patients with primary sclerosing cholangitis (PSC) who have already undergone ERCP-based management — including balloon dilatation of the dominant stricture with antibiotic prophylaxis — but have not achieved the expected therapeutic goals. It defines the next clinical step when that approach proves insufficient.

Previous treatment & failure condition

The preceding line consisted of ERCP with balloon dilatation of the dominant stricture, with peri-procedure antibiotic prophylaxis to prevent post-ERCP cholangitis. The intended outcomes — relief of symptoms, diminished pruritus, and resolution of cholangitis — were not achieved. Non-achievement of these goals is the trigger for escalation to this protocol.

Next-line approach (partial summary)

This protocol addresses the role of liver transplantation in PSC patients with advanced liver disease — the full eligibility criteria and clinical decision pathway are available in the structured regimen.

Instant Access to Structured Evidence-Based Regimens

References

DOI: 10.1038/ajg.2015.112

Liver transplantation, when possible, is recommended over medical therapy or surgical drainage in PSC patients with decompensated cirrhosis, to prolong survival.

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