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| Item Type: | Article |
|---|---|
| Title: | Long-term impact of scheduled regular endoscopic interventions for patients with primary sclerosing cholangitis |
| Creators Name: | Özdirik, B., Veltzke-Schlieker, W., Nicklaus, J.M., Berger, H., Schmidt, D., Leonhardt, S., Penndorf, V., Adler, A., Müller, T., Wree, A., Tacke, F. and Sigal, M. |
| Abstract: | BACKGROUND: Primary sclerosing cholangitis (PSC) is associated with biliary obstructions that can require endoscopic retrograde cholangiopancreatography (ERCP). While the beneficial effects of ERCP are well documented, follow-up interventional strategies are less defined, and their long-term impact is debated. METHODS: We evaluated the outcome of a scheduled program of ERCP-guided interventions that have been developed and implemented at our tertiary liver center for more than 20 years. Within our center, follow-up ERCPs were performed at regular intervals to treat previously detected morphological stenosis independent of clinical symptoms. We calculated the transplant-free survival (TFS) of patients who were enrolled in the scheduled ERCP program and compared it to patients who received follow-up ERCPs only on clinical demand. Moreover, we documented the occurrence of hepatic decompensation, recurrent cholangitis episodes, hepatobiliary malignancies, and endoscopy-related adverse events. RESULTS: In our retrospective study, we included 201 patients with PSC who all received an ERCP. In all, 133 patients received scheduled follow-up ERCPs and 68 received follow-up ERCPs only on demand. The rates of TFS since initial diagnosis (median TFS: 17 vs. 27 y; P = 0.020) and initial presentation (median TFS: 16 vs. 11 y; P = 0.002) were higher in patients receiving scheduled versus on-demand ERCP. Subgroup analysis revealed that progression in cholangiographic findings between the first and second ERCP was associated with a poorer outcome compared to patients without progression (17 y vs. undefined; P = 0.021). CONCLUSION: In conclusion, we report the outcome data of a scheduled follow-up ERCP program for patients with PSC in an experienced high-volume endoscopy center. Our data suggest the initiation of multicenter randomized controlled prospective trials to explore the full potential of regular endoscopic follow-up treatment as a strategy to prevent disease progression in patients with PSC. |
| Keywords: | Endoscopic Retrograde Cholangiopancreatography, Sclerosing Cholangitis, Liver Transplantation, Retrospective Studies, Treatment Outcome |
| Source: | Hepatology Communications |
| ISSN: | 2471-254X |
| Publisher: | Wolters Kluwer Health |
| Volume: | 8 |
| Number: | 9 |
| Page Range: | e0494 |
| Date: | September 2024 |
| Official Publication: | https://doi.org/10.1097/hc9.0000000000000494 |
| PubMed: | View item in PubMed |
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