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.
