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Impact on follow-up strategies in patients with primary sclerosing cholangitis
Department of Medicine Huddinge, Unit of Gastroenterology and Rheumatology, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden; European Reference Network for Hepatological Diseases, Stockholm, Sweden.
Department of Internal Medicine I, University Hospital Bonn, University of Bonn, Bonn, Germany.
Division of Digestive Health and Liver Diseases, University of Miami, Miami, FL, USA; Schiff Center for Liver Diseases, University of Miami, Miami, FL, USA.
Department of Gastroenterology, Infectious Diseases, Intoxication, Heidelberg University Hospital, Heidelberg, Germany.
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2023 (English)In: Liver international (Print), ISSN 1478-3223, E-ISSN 1478-3231, Vol. 43, no 1, p. 127-138Article in journal (Refereed) Published
Abstract [en]

BACKGROUND & AIMS: Evidence for the benefit of scheduled imaging for early detection of hepatobiliary malignancies in primary sclerosing cholangitis (PSC) is limited. We aimed to compare different follow-up strategies in PSC with the hypothesis that regular imaging improves survival.

METHODS: We collected retrospective data from 2,975 PSC patients from 27 centers. Patients were followed from the start of scheduled imaging or in case of clinical follow-up from January 1, 2000, until death or last clinical follow-up alive. The primary endpoint was all-cause mortality.

RESULTS: A broad variety of different follow-up strategies were reported. All except one center used regular imaging, ultrasound (US) and/or magnetic resonance imaging (MRI). Two centers used scheduled ERCP in addition to imaging for surveillance purposes. The overall HR (CI95%) for death, adjusted for sex, age and start year of follow-up, were 0.61 (0.47-0.80) for scheduled imaging with and without ERCP; 0.64 (0.48-0.86) for US/MRI and 0.53 (0.37-0.75) for follow-up strategies including scheduled ERCP. The lower risk of death remained for scheduled imaging with and without ERCP after adjustment for cholangiocarcinoma (CCA) or high-grade dysplasia as a time-dependent covariate, HR 0.57 (0.44-0.75). Hepatobiliary malignancy was diagnosed in 175 (5.9%) of the patients at 7.9 years follow-up. Asymptomatic patients (25%) with CCA had better survival if scheduled imaging had been performed.

CONCLUSIONS: Follow-up strategies vary considerably across centers. Scheduled imaging was associated with improved survival. Multiple factors may contribute to this result including early tumor detection and increased endoscopic treatment of asymptomatic benign biliary strictures.

Place, publisher, year, edition, pages
Wiley-Blackwell Publishing Inc., 2023. Vol. 43, no 1, p. 127-138
Keywords [en]
ERCP, MRI, cholangiocarcinoma, follow-up strategy, primary sclerosing cholangitis, surveillance
National Category
Gastroenterology and Hepatology
Identifiers
URN: urn:nbn:se:oru:diva-98957DOI: 10.1111/liv.15286ISI: 000796360700001PubMedID: 35535655Scopus ID: 2-s2.0-85131595748OAI: oai:DiVA.org:oru-98957DiVA, id: diva2:1657444
Funder
Swedish Cancer SocietyStockholm County Council
Note

Funding agency:

Cancer Research Funds of Radiumhemmet

Available from: 2022-05-11 Created: 2022-05-11 Last updated: 2023-01-19Bibliographically approved

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Nyhlin, Nils

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