Burcin Özdirik, Wilfried Veltzke-Schlieker, Jule Marie Nicklaus, Hilmar Berger, Daniel Schmidt, Silke Leonhardt, Volker Penndorf, Andreas Adler, Tobias Müller, Alexander Wree, Frank Tacke, Michael Sigal
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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.</p><p><strong>Results: </strong>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. 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引用次数: 0
摘要
背景：原发性硬化性胆管炎（PSC）与胆道梗阻有关，需要进行内镜逆行胰胆管造影术（ERCP）。虽然ERCP的有益效果有据可查，但后续介入策略却不太明确，其长期影响也存在争议：我们评估了ERCP引导下介入治疗计划的效果，该计划已在我们的三级肝病中心制定并实施了20多年。在我们中心，每隔一段时间都会进行ERCP随访，以治疗之前发现的形态学狭窄，而与临床症状无关。我们计算了参加定期ERCP计划的患者的无移植生存率（TFS），并将其与仅根据临床需求接受随访ERCP的患者进行了比较。此外，我们还记录了肝功能失代偿、胆管炎复发、肝胆恶性肿瘤和内镜相关不良事件的发生情况：在这项回顾性研究中，我们共纳入了 201 名 PSC 患者，他们都接受了 ERCP。其中，133 名患者接受了预定的 ERCP 随访，68 名患者仅根据需要接受了 ERCP 随访。与按需接受ERCP的患者相比，按计划接受ERCP的患者自初次诊断以来的TFS率（中位数TFS：17年 vs. 27年；P = 0.020）和初次发病率（中位数TFS：16年 vs. 11年；P = 0.002）更高。亚组分析显示，与没有进展的患者相比，第一次和第二次ERCP之间胆管造影结果的进展与较差的预后有关（17年 vs. 未定义；P = 0.021）：总之，我们报告了在一家经验丰富的大容量内镜中心对PSC患者进行定期随访ERCP计划的结果数据。我们的数据建议启动多中心随机对照前瞻性试验，以探索定期内镜随访治疗作为预防 PSC 患者疾病进展策略的全部潜力。
Long-term impact of scheduled regular endoscopic interventions for patients with primary sclerosing cholangitis.
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.
期刊介绍：
Hepatology Communications is a peer-reviewed, online-only, open access journal for fast dissemination of high quality basic, translational, and clinical research in hepatology. Hepatology Communications maintains high standard and rigorous peer review. Because of its open access nature, authors retain the copyright to their works, all articles are immediately available and free to read and share, and it is fully compliant with funder and institutional mandates. The journal is committed to fast publication and author satisfaction.
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