Received:26 July 2022 Accepted:26 July 2022D0t10.1002hep.32771AASLDPRACTICE GUIDANCEAASLD practice guidance on primary sclerosingcholangitis and cholangiocarcinomaChristopher L.Bowlus1 Lionel Arrive2 Annika Bergquist3http://jounMark Deneau Lisa Forman5 Sumera I.llyas5 Keri E.Lunsford?D33Mercedes Martinez8 Gonzalo Sapisochin9 Rachna Shroff10OR,James H.Tabibian11 David N.Assis12Division of Gastroenterology,University of Califomia Davis Health,Sacramento,Califomia,USA2Hopital Saint-Antoine,Paris,FranceKarolinska Institutet,Karolinska University Hospital,Stockholm,SwedenVC4/OAVUniversity of Utah,Salt Lake City,Utah,USA5University of Colorado,Aurora,Colorado,USApDDa8K2+Ya6H51Mayo Clinic College of Medicine and Science,Rochester,Minnesota,USA7Rutgers University-New Jersey Medical School,Newark,New Jersey,USAVagelos College of Physicians and Surgeons,Columbia University.New York,New York,USAUniversity of Toronto,Toronto,Ontario,Canada18E-10University of Arizona,Tucson,Arizona,USA11David Geffen School of Medicine at UCLA Los Angeles,Califomia,USA05/10202312Yale School of Medicine,New Haven,Connecticut,USACorrespondenceChristopher L.Bowlus,Division of Gastroenterology,Univers ity of Califomia,Davis,4150 V Street,Suite 3500,Sacramento,CA 95817,USAEmail:clbowlus@ucdavis.eduWHAT'S NEW SINCE THE 2010hepatic ducts associated with signs or symptoms ofGUIDELINES?obstructive cholestasis and/or bacterial cholangitis(Table 1).Inclusion of guidance for the diagnosis and manage-In patients with equivocal MRI with cholangiopancreatog-ment of cholangiocarcinoma (CCA)in patients withraphy (MRI/MRCP)findings,a repeated high-quality MRI/and without primary sclerosing cholangitis (PSC)MRCP should be performed for diagnostic purpo-(Figures 5,8,and 9).ses.Endoscopic retrograde cholangiopancreatographyIntroduction of the tem relevant stricture,defined as(ERCP)should be avoided for the diagnosis of PSCany biliary stricture of the common hepatic duct or(Figure 2).Abbreviations:AASLD,American Association for the Study of Liver Diseases;AlH,autoimmune hepatitis;ALP,alkaline phosphatase;ASIR,age standardizedincidence rate;AST,aspartate aminotransferase;BRAF,B-raf proto-oncogene;CA 19-9,carbohydrate antigen 19-9;CCA,cholangiocarcinoma;CRC,colorectalcancer;3D,three-dimensional;dCCA,distal cholangiocarcinoma;debTACE,drug-eluting bead transarterial chemoembolization;ECOG,Eastem CooperationOncology Group;ELF,Enhanced Liver Fibrosis;ERCP,endoscopic retrograde cholangiopancreatography;EUS,endoscopic ultrasound;FDA,Food and DrugAdministration;FGFR2,FGF receptor 2;FISH,fluorescent in situ hybridization;FNA,fine-needle aspiration;FOLFOX,5-FU and oxaliplatin;5-FU,5-fluorouracil;FUT,fucosyltransferases;gem/cis,gemcitabine/cisplatin;GGT,y-glutamyl transferase;HGD,high-grade dysplasia;IBD,inflammatory bowel disease;iCCA,intrahepaticcholangiocarcinoma;ICD,Intemational Classification of Diseases;IDH,isocitrate dehydrogenase:LN,lymph node;LRT,locoregional therapy:LS,liverstiffness;LT,liver transpl
