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Impact on follow-up strategies in patients with primary sclerosing cholangitis.

Liver international : official journal of the International Association for the Study of the Liver

Authors: Annika Bergquist, Tobias J Weismüller, Cynthia Levy, Christian Rupp, Deepak Joshi, Jeremy Shanika Nayagam, Aldo J Montano-Loza, Ellina Lytvyak, Ewa Wunsch, Piotr Milkiewicz, Roman Zenouzi, Christoph Schramm, Nora Cazzagon, Annarosa Floreani, Ingalill Friis Liby, Miriam Wiestler, Heiner Wedemeyer, Taotao Zhou, Christian P Strassburg, Eirini Rigopoulou, George Dalekos, Manasa Narasimman, Xavier Verhelst, Helena Degroote, Mette Vesterhus, Andreas E Kremer, Bennet Bündgens, Fredrik Rorsman, Emma Nilsson, Kristin Kaasen Jørgensen, Erik von Seth, Martin Cornillet Jeannin, Nils Nyhlin, Harry Martin, Stergios Kechagias, Kristine Wiencke, Mårten Werner, Benedetta Terziroli Beretta-Piccoli, Marco Marzioni, Helena Isoniemi, Johanna Arola, Agnes Wefer, Jonas Söderling, Martti Färkkilä, Henrike Lenzen

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 2975 PSC patients from 27 centres. Patients were followed from the start of scheduled imaging or in case of clinical follow-up from 1 January 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 centre used regular imaging, ultrasound (US) and/or magnetic resonance imaging (MRI). Two centres used scheduled endoscopic retrograde cholangiopancreatography (ERCP) in addition to imaging for surveillance purposes. The overall HR (CI95%) for death, adjusted for sex, age and start year of follow-up, was 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 of follow-up. Asymptomatic patients (25%) with CCA had better survival if scheduled imaging had been performed.

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

© 2022 The Authors. Liver International published by John Wiley & Sons Ltd.

PMID: 35535655

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