The validity and safety of endoscopic biliary stenting for the associated biliary stenosis during CS therapy and successful removal one month after the steroid initiation have been reported[25]. effect, with the smooth decrease in serum IgG4 and the improvement of the bile duct wall thickness. CONCLUSION As isolated type 2b, IgG4-SC is rare, the images, histological findings, and clinical course of our case will be helpful for physicians to diagnose and treat the new cases appropriately. et alan autoimmune mechanism, the response to CS therapy is also one of the diagnostic criteria for the disease. The validity and safety of endoscopic biliary stenting for the associated biliary stenosis during CS therapy and successful removal one month after the steroid initiation have been reported[25]. On the other hand, Miyazawa em et al /em [26] reported that IgG4-SC-related obstructive jaundice without infection can be RU 24969 hemisuccinate treated safely with CS monotherapy without drainage. These reports suggest the sensitivity of this disease to CS among the variety of other cholangitis and cholestatic liver diseases[27]. Oral administration of prednisolone at 0.6 mg/kg/day is recommended for the induction of remission, followed by the gradual reduction to a maintenance dose of 5 mg/day over 2-3 mo, with which our case showed a good clinical course with the doses, and a decrease in serum IgG4, biliary enzymes, and wall thickness of the bile duct (Figure ?(Figure3).3). The improvement of the wall thickness was able to be evaluated by the transabdominal US reflecting the response to prednisolone (PSL). As the transabdominal US is noninvasive and the response to PSL is one of the key phenomena differentially diagnosing from the cholangiocarcinoma, the findings presented here demonstrated the usefulness of US[20] (Table ?(Table33). CONCLUSION In conclusion, we reported the rare case of isolated IgG4-SC of Type 2b in an elderly patient, successfully treated with CS. Our summary demonstrated the usefulness of ultrasonography for the assessment of the response to the therapy. Footnotes Informed consent statement: Written informed consent was obtained from the patient for publication of this case report and the accompanying images. Conflict-of-interest statement: The authors declare that they have no current financial arrangement or affiliation with any organization that may have a direct influence on their work. CARE Checklist (2016) statement: CARE Checklist (2016) of information was?included and the form was attached. Manuscript source: Invited manuscript Peer-review started: September 5, 2020 First decision: September 30, 2020 Article in press: October 26, 2020 Specialty type: Medicine, research and experimental Country/Territory of origin: Japan Peer-review reports scientific quality classification Grade A (Excellent): 0 Grade B (Very good): B Grade C (Good): C Grade D (Fair): 0 Grade E (Poor): 0 P-Reviewer: Fan RY, Liu QC S-Editor: Zhang L L-Editor: A P-Editor: Xing YX Contributor Information Yuto RU 24969 hemisuccinate Tanaka, Division of Gastroenterology and Hepatology, Graduate School of Medical and Dental Sciences, Niigata University, Niigata 9518510, Japan. Kenya Kamimura, Division of Gastroenterology and Hepatology, Graduate School of Medical and Dental Sciences, Niigata University, Niigata 9518510, Japan. pj.ca.u-atagiin.dem@k-aynek. Ryota Nakamura, Division of Gastroenterology and Hepatology, Graduate School of Medical and Dental Sciences, Niigata University, Niigata 9518510, Japan. Marina Ohkoshi-Yamada, Division of Gastroenterology and Hepatology, Graduate School of Medical and Dental Sciences, Niigata University, Niigata 9518510, Japan. Yohei Koseki, Division of Gastroenterology and Hepatology, Graduate School of Medical and Dental Sciences, Niigata University, Niigata 9518510, Japan. Takeshi Mizusawa, Division of Gastroenterology and Hepatology, Graduate School of Medical and Dental Sciences, Niigata University, Niigata 9518510, Japan. Satoshi Ikarashi, Division of Gastroenterology and Hepatology, Graduate School of Medical and Dental Sciences, Niigata University, Niigata 9518510, Japan. Kazunao RU 24969 hemisuccinate Hayashi, Division of Gastroenterology and Hepatology, Graduate School of Medical and Dental Sciences, Niigata RU 24969 hemisuccinate University, Niigata 9518510, Japan. Hiroki Sato, Division of Gastroenterology and Hepatology, Graduate School of Medical and Dental Sciences, Niigata University, Niigata 9518510, Japan. Akira Sakamaki, Division of Gastroenterology and Hepatology, Graduate School of Medical and Dental Sciences, Niigata University, Niigata 9518510, Japan. Junji Yokoyama, Division of Gastroenterology and Hepatology, Graduate School of Medical and Dental Sciences, Niigata University, Niigata 9518510, Japan. Shuji Terai, Rabbit Polyclonal to OR4A16 Division of Gastroenterology and Hepatology, Graduate School of Medical and Dental Sciences, Niigata University, Niigata 9518510, Japan..