Impact on follow-up strategies in patients with primary sclerosing cholangitis
(2023) In Liver International 43(1). p.127-138- Abstract
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... (More)
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.
(Less)
- author
- author collaboration
- organization
- publishing date
- 2023
- type
- Contribution to journal
- publication status
- published
- subject
- keywords
- cholangiocarcinoma, ERCP, follow-up strategy, MRI, primary sclerosing cholangitis, surveillance
- in
- Liver International
- volume
- 43
- issue
- 1
- pages
- 12 pages
- publisher
- Wiley-Blackwell
- external identifiers
-
- pmid:35535655
- scopus:85131595748
- ISSN
- 1478-3223
- DOI
- 10.1111/liv.15286
- language
- English
- LU publication?
- yes
- id
- 62ee1af6-cea4-4971-a58d-1ddb22b84d13
- date added to LUP
- 2023-02-08 14:39:10
- date last changed
- 2024-09-17 08:37:19
@article{62ee1af6-cea4-4971-a58d-1ddb22b84d13,
abstract = {{<p>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.</p>}},
author = {{Bergquist, Annika and Weismüller, Tobias J. and Levy, Cynthia and Rupp, Christian and Joshi, Deepak and Nayagam, Jeremy Shanika and Montano-Loza, Aldo J. and Lytvyak, Ellina and Wunsch, Ewa and Milkiewicz, Piotr and Zenouzi, Roman and Schramm, Christoph and Cazzagon, Nora and Floreani, Annarosa and Liby, Ingalill Friis and Wiestler, Miriam and Wedemeyer, Heiner and Zhou, Taotao and Strassburg, Christian P. and Rigopoulou, Eirini and Dalekos, George and Narasimman, Manasa and Verhelst, Xavier and Degroote, Helena and Vesterhus, Mette and Kremer, Andreas E. and Bündgens, Bennet and Rorsman, Fredrik and Nilsson, Emma and Jørgensen, Kristin Kaasen and von Seth, Erik and Cornillet Jeannin, Martin and Nyhlin, Nils and Martin, Harry and Kechagias, Stergios and Wiencke, Kristine and Werner, Mårten and Beretta-Piccoli, Benedetta Terziroli and Marzioni, Marco and Isoniemi, Helena and Arola, Johanna and Wefer, Agnes and Söderling, Jonas and Färkkilä, Martti and Lenzen, Henrike}},
issn = {{1478-3223}},
keywords = {{cholangiocarcinoma; ERCP; follow-up strategy; MRI; primary sclerosing cholangitis; surveillance}},
language = {{eng}},
number = {{1}},
pages = {{127--138}},
publisher = {{Wiley-Blackwell}},
series = {{Liver International}},
title = {{Impact on follow-up strategies in patients with primary sclerosing cholangitis}},
url = {{http://dx.doi.org/10.1111/liv.15286}},
doi = {{10.1111/liv.15286}},
volume = {{43}},
year = {{2023}},
}