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• W4283160882 abstract "<h3>Introduction</h3> Guidelines for CCA surveillance in PSC vary. The 2019 BSG guidelines suggest annual ultrasound (for gallbladder polyp detection), but not serum Ca-19.9 monitoring. The 2019 AGA guidelines recommend 6-12-monthly surveillance imaging +/- serum Ca-19.9. Some centres perform annual MRI imaging. In a UK multicentre audit of PSC, 71% of patients were undergoing “annual CCA surveillance” but frequency of tests performed was not assessed. More information is needed on practice and efficacy of CCA surveillance in PSC. <h3>Methods</h3> Single-centre retrospective audit of hepatobiliary imaging and serum Ca-199, in patients with PSC, and of CCAs diagnosed. Patients with PSC attending 2015-2021 were collected from Unit and HPB MDT databases. Details of hepatobiliary imaging (ultrasound, CT or MRI) and serum Ca-199 measurements were obtained. Each patient was eligible for surveillance from the year after that of PSC diagnosis or from 1/1/2015, until censored (death, transplant- unless PSC recurred-, CCA diagnosis, loss to follow up or decision to stop (usually frailty)). <h3>Results</h3> 105 patients (67 men) with PSC were seen (diagnosed 1981-2021, 99 on MRCP, 6 on liver biopsy). Age in 2018 was (median(range) 54(17-87) years. 73 had IBD, 11 had undergone liver transplantation, with PSC recurrence in two. of the total of 477 patient-years, during which patients were eligible for surveillance, MRCP had been performed during 36%, any form of hepatobiliary imaging during 73%, and serum Ca-199 during 50%. These percentages increased between 2015/16 and 2020/21: from 23% to 47% (MRCP), from 60% to 81% (any imaging) and from 40% to 60% for serum Ca-19.9 (all p<0.01 by Chi2). Six patients (5 men) were diagnosed with CCA (all intrahepatic), aged 57(27-69) years and 4(0.5-14) years after PSC diagnosis. Four were unresectable and two (diameter 4.0-4.5 cm) were resected but recurred after 12 months. Prior to CCA diagnosis, one patient had not undergone imaging for 31 months, one had normal abdominal ultrasound 9 months before, and in the other four, MRCP 4-7 months before (and cholangioscopy in one) did not report CCA, despite contemporaneous raised serum Ca-199 in two. Three other PSC patients developed colorectal cancer (all resected, no recurrence), two developed gallbladder polyps with high-grade dysplasia (both resected) and none, hepatocellular carcinoma. <h3>Conclusions</h3> A substantial, though declining proportion of eligible patients with PSC do not undergo regular surveillance for CCA; this may have delayed diagnosis in one patient. In two others, a rise in serum Ca-199 preceded radiological diagnosis. Surveillance for CCA needs to be more rigorously instituted and needs to be improved." @default.
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• W4283160882 date "2022-06-01" @default.
• W4283160882 modified "2023-10-02" @default.
• W4283160882 title "P74 Audit of investigations performed for cholangiocarcioma surveillance in patients with primary sclerosing cholangitis" @default.
• W4283160882 doi "https://doi.org/10.1136/gutjnl-2022-bsg.131" @default.
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