**3.6 Proposed diagnostic criteria**

Matsumoto et al. revealed a characteristic feature of EC that helped rule out malignancy: staining of a parenchymal echo in the bile duct wall on

#### **Figure 4.**

*This positron emission tomography-computed tomography (PET-CT) reveals a soft tissue lesion within the main left biliary duct but does not show any fluorodeoxyglucose (FDG) activity. This still does not exclude cholangiocarcinoma.*

contrast-enhanced ultrasound (CEUS). However, they suggested the following requirements to accurately diagnose EC [6]:


### **3.7 Treatment**

Even though EC is a self-limiting disease, it has a variable course, making precise treatment recommendations difficult. The challenge remains to exclude malignancy, which is not always possible with various imaging modalities and biopsies. Hence, mandatory surgical intervention is an effective and definitive measure of treating EC if there is diagnostic uncertainty.

According to the literature, two cases of EC described a stricture in the common hepatic duct that regressed spontaneously without any medical intervention within 3 weeks, but most of the published cases of EC were treated surgically and received a retrograde diagnosis (see **Figure 5**) [10].

Seow-En et al. suggested that the best option to simultaneously treat a stricture, exclude malignancy, and attain a definite diagnosis of EC is surgical intervention. They also described the advantages of surgery over medical therapy, indicating that medical treatment does not eradicate the chance of recurrence and that it could put patients at risk of complications of repeated steroid therapy [11].

#### **Figure 5.**

*(a) Severe degree of periductal onion skin fibrosis (hematoxylin and eosin stain displaying 2× magnification). (b and c) The inflammatory infiltrates around the partially damaged bile duct are mostly eosinophilic cells (hematoxylin and eosin stain displaying 10× magnification). (d) The eosinophilic count exceeds 40 cells per HPF (hematoxylin and eosin stain displaying 40× magnification).*

**179**

**Author details**

Gilles Jadd Hoilat1

and Divey Manocha1

United States of America

, Judie Noemie Hoilat2

1 State University of New York Upstate Medical University, Syracuse,

2 Alfaisal University College of Medicine, Riyadh, Saudi Arabia

3 Ascension St. John Hospital, Detroit, United States of America

© 2019 The Author(s). Licensee IntechOpen. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/ by/3.0), which permits unrestricted use, distribution, and reproduction in any medium,

\*Address all correspondence to: manochad@upstate.edu

\*

provided the original work is properly cited.

, Mohamad Fekredeen Ayas3

, Sana Riaz1

*Eosinophilic Cholangitis*

**4. Conclusion**

*DOI: http://dx.doi.org/10.5772/intechopen.86004*

and receive a retrograde diagnosis.

the poor understanding of the diseased natural course.

A diagnostic trial of oral corticosteroid can be tried to see if any resolution occurs, however the dose and duration of treatment are yet to be determined due to

In conclusion, EC is an uncommon, benign, and self-limiting cause of biliary stricture. Although this disease has a good response to corticosteroid therapy, it often mimics cholangiocarcinoma which makes reaching a definite diagnosis by clinical and radiological findings difficult. Hence most cases are treated surgically

A diagnostic trial of oral corticosteroid can be tried to see if any resolution occurs, however the dose and duration of treatment are yet to be determined due to the poor understanding of the diseased natural course.
