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

Annika Bergquist, Tobias J. Weismueller, Cynthia Levy, Christian Rupp, Deepak Joshi, Jeremy Shanika Nayagam, Aldo J. Montano-Loza, Ellina Lytvyak, Ewa Wunsch, Piotr Milkiewicz, et al.
(2023) LIVER INTERNATIONAL. 43(1). p.127-138
Author
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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 (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.
Keywords
surveillance, primary sclerosing cholangitis, MRI, follow-up strategy, ERCP, cholangiocarcinoma

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MLA
Bergquist, Annika, et al. “Impact on Follow-up Strategies in Patients with Primary Sclerosing Cholangitis.” LIVER INTERNATIONAL, vol. 43, no. 1, 2023, pp. 127–38, doi:10.1111/liv.15286.
APA
Bergquist, A., Weismueller, T. J., Levy, C., Rupp, C., Joshi, D., Nayagam, J. S., … Lenzen, H. (2023). Impact on follow-up strategies in patients with primary sclerosing cholangitis. LIVER INTERNATIONAL, 43(1), 127–138. https://doi.org/10.1111/liv.15286
Chicago author-date
Bergquist, Annika, Tobias J. Weismueller, Cynthia Levy, Christian Rupp, Deepak Joshi, Jeremy Shanika Nayagam, Aldo J. Montano-Loza, et al. 2023. “Impact on Follow-up Strategies in Patients with Primary Sclerosing Cholangitis.” LIVER INTERNATIONAL 43 (1): 127–38. https://doi.org/10.1111/liv.15286.
Chicago author-date (all authors)
Bergquist, Annika, Tobias J. Weismueller, 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 Buendgens, Fredrik Rorsman, Emma Nilsson, Kristin Kaasen Jorgensen, Erik von Seth, Martin Cornillet Jeannin, Nils Nyhlin, Harry Martin, Stergios Kechagias, Kristine Wiencke, Marten Werner, Benedetta Terziroli Beretta-Piccoli, Marco Marzioni, Helena Isoniemi, Johanna Arola, Agnes Wefer, Jonas Soderling, Martti Farkkila, and Henrike Lenzen. 2023. “Impact on Follow-up Strategies in Patients with Primary Sclerosing Cholangitis.” LIVER INTERNATIONAL 43 (1): 127–138. doi:10.1111/liv.15286.
Vancouver
1.
Bergquist A, Weismueller TJ, Levy C, Rupp C, Joshi D, Nayagam JS, et al. Impact on follow-up strategies in patients with primary sclerosing cholangitis. LIVER INTERNATIONAL. 2023;43(1):127–38.
IEEE
[1]
A. Bergquist et al., “Impact on follow-up strategies in patients with primary sclerosing cholangitis,” LIVER INTERNATIONAL, vol. 43, no. 1, pp. 127–138, 2023.
@article{01GQMC8CF5ZP94BSW6WPS356TH,
  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 (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.}},
  author       = {{Bergquist, Annika and  Weismueller, 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  Buendgens, Bennet and  Rorsman, Fredrik and  Nilsson, Emma and  Jorgensen, Kristin Kaasen and  von Seth, Erik and  Cornillet Jeannin, Martin and  Nyhlin, Nils and  Martin, Harry and  Kechagias, Stergios and  Wiencke, Kristine and  Werner, Marten and  Beretta-Piccoli, Benedetta Terziroli and  Marzioni, Marco and  Isoniemi, Helena and  Arola, Johanna and  Wefer, Agnes and  Soderling, Jonas and  Farkkila, Martti and  Lenzen, Henrike}},
  issn         = {{1478-3223}},
  journal      = {{LIVER INTERNATIONAL}},
  keywords     = {{surveillance,primary sclerosing cholangitis,MRI,follow-up strategy,ERCP,cholangiocarcinoma}},
  language     = {{eng}},
  number       = {{1}},
  pages        = {{127--138}},
  title        = {{Impact on follow-up strategies in patients with primary sclerosing cholangitis}},
  url          = {{http://doi.org/10.1111/liv.15286}},
  volume       = {{43}},
  year         = {{2023}},
}
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