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

Bergquist A, Weismueller TJ, Levy C, Rupp C, Joshi D, Nayagam JS, Montano-Loza AJ, Lytvyak E, Wunsch E, Milkiewicz P, Zenouzi R, Schramm C, Cazzagon N, Floreani A, Liby IF, Wiestler M, Wedemeyer H, Zhou T, Strassburg CP, Rigopoulou E, Dalekos G, Narasimman M, Verhelst X, Degroote H, Vesterhus M, Kremer A, Buendgens B, Rorsman F, Nilsson E, Jorgensen KK, Von Seth E, Cornillet Jeannin M, Nyhlin N, Martin H, Kechagias S, Wiencke K, Werner M, Beretta-Piccoli BT, Marzioni M, Isoniemi H, Arola J, Wefer A, Soderling J, Farkkila M, Lenzen H (2022)

Publication Type: Journal article

Publication year: 2022


DOI: 10.1111/liv.15286


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.

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Involved external institutions

Karolinska University Hospital / Karolinska Universitetssjukhuset SE Sweden (SE) Rheinische Friedrich-Wilhelms-Universität Bonn DE Germany (DE) General University Hospital of Larissa GR Greece (GR) Universitätsklinikum Hamburg-Eppendorf (UKE) DE Germany (DE) University of Padua / Universita degli Studi di Padova IT Italy (IT) Wrocław Medical University / Uniwersytet Medyczny we Wrocławiu PL Poland (PL) University of Alberta CA Canada (CA) Medizinische Hochschule Hannover (MHH) / Hannover Medical School DE Germany (DE) Università della Svizzera italiana (USI) CH Switzerland (CH) Örebro University SE Sweden (SE) Sahlgrenska University Hospital / Sahlgrenska Universitetssjukhuset SE Sweden (SE) Oslo University Hospital / Oslo Universitetssykehus Rikshospitalet NO Norway (NO) University Hospital Ghent BE Belgium (BE) King's College Hospital (KCH) GB United Kingdom (GB) University of Miami US United States (USA) (US) Linköpings universitet / Linköping University SE Sweden (SE) Helsingin yliopisto / University of Helsinki FI Finland (FI) Universitätsklinikum Heidelberg DE Germany (DE) Helsinki University Central Hospital (HUCH) / Helsingin seudun yliopistollinen keskussairaala (HYKS) FI Finland (FI) Università Politecnica delle Marche (UNIVPM) / Marche Polytechnic University IT Italy (IT) Umeå University SE Sweden (SE) Universität Duisburg-Essen (UDE) DE Germany (DE) Universiteit Gent (UGent) / Ghent University BE Belgium (BE) Karolinska Institute SE Sweden (SE) Uppsala University Hospital / Akademiska sjukhuset SE Sweden (SE) Akershus University Hospital / Akershus universitetssykehus (Ahus) NO Norway (NO) Lund University / Lunds universitet SE Sweden (SE) University College London Hospitals (UCLH) GB United Kingdom (GB)

How to cite


Bergquist, A., Weismueller, T.J., Levy, C., Rupp, C., Joshi, D., Nayagam, J.S.,... Lenzen, H. (2022). Impact on follow-up strategies in patients with primary sclerosing cholangitis. Liver International.


Bergquist, Annika, et al. "Impact on follow-up strategies in patients with primary sclerosing cholangitis." Liver International (2022).

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