Subject Area

Endemic and Tropical Medicine

Article Type

Original Study


Objectives The aim of the present study was to assess the levels of serum immunoglobulin G4 (IgG4) in patients with distal common bile duct strictures in patients with benign biliary stricture (BBS). Background Biliary strictures frequently present a challenge in terms of diagnosis, which requires a multidisciplinary approach. Although up to 30% of biliary strictures can be benign, the vast majority are malignant, the two major malignancies being pancreatic adenocarcinoma and cholangiocarcinoma. One of the underdiagnosed causes of BBS is IgG4-associated cholangiopathy. Increased serum IgG4 levels can be observed in most patients with IgG4-related disease. Patients and methods Sixty-two patients with obstructive jaundice attending the endoscopy unit of National Liver Institute, Menoufia University, for endoscopic retrograde cholangiopancreatography in the duration from April 2019 to February 2020, were included in the present study. Twenty seven of them with BBSs, and the other 35 have malignant biliary strictures (MBSs). Another 35 healthy individuals of matched age and sex were included as a control group. Serum IgG4 was determined by ELISA. Results There was a high statistically significant difference regarding serum IgG4 between benign and control group and benign and malignant group. Serum IgG4 level above 134.95 mg/dl has specificity 82.86% and sensitivity 96.3% in distinguishing BBS from MBS. Serum IgG4 level above 129.8 mg/dl has specificity 94.29% and sensitivity 96.3% in distinguishing BBS from control. There was a statistically significant correlation between serum IgG4 level and alkaline phosphatase level (correlation coefficient 0.419). Conclusion A significant proportion of non-MBS could be IgG4-related cholangitis.