AGA Clinical Practice Update on Surveillance for Hepatobiliary Cancers in Patients With Primary Sclerosing Cholangitis: Expert Review

Emerging therapies in primary sclerosing cholangitis: pathophysiological basis and clinical opportunities

“…25.6 [? 13.4%] and -9.8 [-2.8%] in the 1 mg and 3 mg treatment arms compared to -0.6 for placebo; P = 0.43 and 0.65 for treatment groups compared to placebo) [107]. However, findings in exploratory endpoints might indicate improvement of hepatic injury and fibrosis (DELF test: -0.3 for both treatment groups vs 0.1 for placebo, P = 0.049 and 0.02 for 1 and 3 mg compared to placebo; DPRO-C3: -6.3, -9.0 and 3.5 for 1 mg, 3 mg and placebo groups, P = 0.01 and 0.001 for 1 and 3 mg compared to placebo) and reduction in C4 (-6.2 and -9.4 ng/ml in 1 mg and 3 mg treatment groups) and bile acids (total endogenous bile acids: -19.7, -9.6 and -4.1 in 1 mg, 3 mg and placebo groups; P = 0.16 and 0.04 for 1 and 3 mg compared to placebo).…”

“…Current tools for early detection of CCA perform poorly; however, annual screening by hepatobiliary imaging and full ileocolonoscopy is recommended by international guidelines [12]. There is currently a trend away from annual ultrasound-based screening for gallbladder polyps (and hepatocellular cancer in cirrhotic patients) towards the use of magnetic resonance imaging (MRI) and MRC as the annual screening imaging modality of choice [13,14], but the full utility of various screening modalities for early cancer detection in PSC awaits prospective validation [15].…”

An Overview on Primary Sclerosing Cholangitis

“…Gallbladder masses or polyps are encountered in 4% to 6.5% of patients with PSC, more than half being malignant [4]. Gallbladder polyps over 8 mm are an indication for cholecystectomy in patients with PSC [7].…”

“…Most of the studies from the literature show that PSC is a progressive disease leading to liver failure and death, even though each patient has its disease course ( Table 1). The median time to progress from diagnosis to death or liver transplantation is estimated at 9 to 18 years [7]. To simplify these variations, different prognostic models have been developed in time, the revised Mayo Clinic Risk Score being the most frequently used in medical practice.…”

Issue Highlights

“…S ingle-operator cholangioscopyguided biopsies are considered the most sensitive method of acquiring tissue in patients with indeterminate biliary strictures (IBDS); cholangioscopy (with biopsy) is recommended as the test of choice by the recent AGA Clinical Practice Update. 1 However, the optimal method of processing tissue is unclear. In this issue of Clinical Gastroenterology and Hepatology, Bang et al 2 describe results of the single-operator cholangioscopy randomized trial evaluating specimens (SOCRATES) clinical trial where 62 patients with IBDS were randomized to undergo onsite versus offsite specimen processing.…”