Annual magnetic resonance cholangiopancreatography surveillance outcomes in individuals with primary sclerosing cholangitis

BACKGROUND: Annual surveillance for cholangiocarcinoma using magnetic resonance cholangiopancreatography (MRCP) has been recommended in primary sclerosing cholangitis (PSC) to improve the associated dismal outcomes. However, data are limited. AIMS: To compare the outcomes of surveillance versus non-surveillance in patients with PSC. METHODS: A retrospective cohort of patients with PSC at a liver transplant hospital with hepatologist-directed MRCP surveillance were identified. The surveillance group underwent a MRCP every 12 ± 3 months for at least 70% of the follow-up period. Patients were followed from their first MRCP to cholangiocarcinoma diagnosis, liver transplantation, death or the 30 April 2023. RESULTS: The surveillance group with 108 patients (68%) and non-surveillance group with 50 patients (32%) were similar at baseline, with the median age at PSC diagnosis 38 years (range: 7-78 years), 91 males (59%) and the median duration of MRCP surveillance 86 months (range: 10-257 months). Cholangiocarcinoma was diagnosed in 14 patients (9%) (intrahepatic, n = 10; extrahepatic, n = 4). Surveillance MRCP detected one cholangiocarcinoma of the six patients diagnosed in the surveillance cohort, while 10 patients were diagnosed with cholangiocarcinoma following symptoms or raised liver enzymes. Overall, cumulative survival at 3 and 5 years was significantly improved in the surveillance group compared with the non-surveillance group in multivariate models, adjusting for age, cirrhosis and presence of cholangiocarcinoma (97% vs 77%, and 94% vs 69%, respectively; P < 0.001). CONCLUSION: MRCP surveillance did not detect early cholangiocarcinoma or improve cholangiocarcinoma survival in this retrospective cohort of PSC patients; however, surveillance was associated with improved overall survival compared to no surveillance.