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Endoscopy
DOI: 10.1055/a-2511-3422
Original article

Surveillance of primary sclerosing cholangitis – a comparison of scheduled or on-demand ERCP with annual MRI surveillance: a multicenter study

Nina Barner-Rasmussen
1   Department of Gastroenterology, HUS Abdominal Center, Helsinki University Central Hospital, Helsinki, Finland (Ringgold ID: RIN159841)
,
Antonio Molinaro
2   Department of Molecular and Clinical Medicine, Wallenberg Laboratory, University of Gothenburg, Gothenburg, Sweden (Ringgold ID: RIN3570)
,
Bregje Mol
3   Department of Gastroenterology and Hepatology, Amsterdam UMC Locatie AMC, Amsterdam, Netherlands (Ringgold ID: RIN26066)
,
Cyriel Ponsioen
3   Department of Gastroenterology and Hepatology, Amsterdam UMC Locatie AMC, Amsterdam, Netherlands (Ringgold ID: RIN26066)
,
Annika Bergquist
4   Department of Gastroenterology and Hepatology, Karolinska University Hospital, Stockholm, Sweden (Ringgold ID: RIN59562)
,
Hannu Kautiainen
5   Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland (Ringgold ID: RIN163043)
6   Primary Health Care, Folkhalsan Research Centre, Helsinki, Finland
,
Martti A. Färkkilä
1   Department of Gastroenterology, HUS Abdominal Center, Helsinki University Central Hospital, Helsinki, Finland (Ringgold ID: RIN159841)
› Author AffiliationsSupported by: Finnish Cancer Foundation
Supported by: State Funding for University-level Health Research TYH2020206

Clinical Trial: Registration number (trial ID): NCT03041662, Trial registry: ClinicalTrials.gov (http://www.clinicaltrials.gov/), Type of Study: Prospective
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Referred to by:

Are we ready to change our surveillance strategy for primary sclerosing cholangitis patients?Endoscopy eFirst
DOI: 10.1055/a-2541-3986

Abstract

Background

Primary sclerosing cholangitis (PSC) is associated with a high risk of hepatobiliary malignancy, especially cholangiocarcinoma (CCA). There are no good tumor markers to screen for CCA, and current recommendations for PSC monitoring are mainly based on expert opinions. The optimal strategy to assess disease progression and screen for CCA – the main cause of death of PSC patients – remains unclear. We aimed to compare three different surveillance strategies and their effect on patient outcomes.

Methods

Data from three distinct PSC cohorts with different surveillance strategies – scheduled endoscopic retrograde cholangiopancreatography (ERCP), annual magnetic resonance imaging/cholangiopancreatography (MRI/MRCP) surveillance, and on-demand ERCP according to ESGE/EASL guidelines – was collected. Patients with PSC diagnosed in 1990 or later were included and the last day of follow-up was 31 December 2023. The composite end point consisted of hepatobiliary malignancy, liver transplantation, or liver-related death.

Results

1629 PSC patients were included, with a median follow-up of 8–11 years. The cumulative incidence of the composite end point was lowest in the group undergoing scheduled ERCP (14.1%, 95%CI 12.0%–16.4%) and highest in the on-demand ERCP cohort (35.0%, 95%CI 28.4%–42.0%). Although the cumulative incidence of CCA was lower in the scheduled ERCP group than in the other groups, it did not differ statistically significantly from the MRI/MRCP surveillance group. No differences were seen in liver-related deaths between the surveillance strategies.

Conclusions

In this study comparing scheduled ERCP, annual MRI/MRCP surveillance, and on-demand ERCP, the strategy based on scheduled ERCP using individual risk stratification is associated with better overall prognosis and outcome.

Supplementary Material



Publication History

Received: 30 August 2024

Accepted after revision: 13 December 2024

Article published online:
28 January 2025

© 2025. Thieme. All rights reserved.

Georg Thieme Verlag KG
Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany

 

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