P302 Malignancy surveillance in patients with primary sclerosing cholangitis and Inflammatory Bowel Disease – keeping up with international guidelines? A Norwegian cohort study
Tønjum, T.K.(1);Anisdahl, K.(1,2);Folseraas, T.(3);Midgard, H.(2);Høivik, M.L.(1,2);
(1)University of Oslo, Institute of Clinical Medicine, Oslo, Norway;(2)Oslo University Hospital, Department of Gastroenterology, Oslo, Norway;(3)Oslo University Hospital Rikshospitalet, Section of Gastroenterology & the Norwegian PSC Research Centre- Department of Transplantation Medicine- Division of Surgery- Inflammatory Medicine and Transplantation, Oslo, Norway;
Background
Primary sclerosing cholangitis (PSC), especially PSC in inflammatory bowel disease (PSC-IBD), increases risk of developing several types of cancers, including cholangiocarcinoma (CCA), gall bladder cancer and colorectal cancer (CRC) – highlighting the need for frequent and thorough screening employing several diagnostic modalities, in these patients. We aimed to assess whether current international guidelines for malignancy surveillance were followed for the PSC-IBD population at the Department of Gastroenterology (DoG) at Oslo University Hospital (OUH).
Methods
Data from health records of patients at DoG OUH containing the term ‘PSC’ was screened for IBD and PSC diagnoses, disease activity and severity, as well as follow-up of PSC disease progression and surveillance of PSC-associated malignancies. All data was collected in the last quarter of 2020 and registered in the local IBD registry.
Results
Clinical characteristics [Table 1] and surgical intervention for PSC-IBD [Table 2] are displayed below. In the last year, magnetic resonance cholangiopancreatography (MRCP) was performed in 16 patients (26%), while 47 (78%) had an abdominal ultrasound (US). Colonoscopy or other lower endoscopy was performed within the last year in a total of 42 patients (69%). In those who had not undergone colectomy, 33/40 (83%) underwent colonoscopy in the last year, while 31/40 (78%) had biopsies taken.
Conclusion
Abdominal US and colonoscopy with biopsies should be performed annually in all PSC-IBD patients1,2, meaning, on average, about one fifth of PSC-IBD patients at OUH may be at risk of unnecessary and preventable affliction. Also, there is a void of guidelines regarding CRC screening in colectomised patients. Evidence for screening for CCA with MRCP remains unclear3, but when performed may indicate severe economic impact on public health systems.
References:
1. Chapman MH et al. British Society of Gastroenterology and UK-PSC guidelines for the diagnosis and management of primary sclerosing cholangitis. Gut. 2019;68(8):1356-78.
2. Aabakken L et al. Role of endoscopy in primary sclerosing cholangitis: European Society of Gastrointestinal Endoscopy (ESGE) and European Association for the Study of the Liver (EASL) Clinical Guideline. Endoscopy. 2017;49(6):588-608.
3. Schramm C, Eaton J, Ringe KI, Venkatesh S, Yamamura J. Recommendations on the use of magnetic resonance imaging in PSC - A position statement from the International PSC Study Group. Hepatology. 2017;66(5):1675-88.