Indiana University School of Medicine Indianapolis, IN
Award: Presidential Poster Award
Vijay S. Are, MBBS, Raj Vuppalanchi, MD, Gail H. Vance, MD, Glen A. Lehman, MD, Evan L. Fogel, MD, James L. Watkins, MD, Jeffrey J. Easler, MD, Benjamin L. Bick, MD, Aditya Gutta, MD, Naga Chalasani, MD, FACG, Stuart Sherman, MD, Mark A. Gromski, MD; Indiana University School of Medicine, Indianapolis, IN
Introduction: Primary sclerosing cholangitis (PSC) is a known risk factor for cholangiocarcinoma (CCA). The utility of fluorescence in situ hybridization (FISH) in evaluating strictures found during endoscopic retrograde cholangiopancreatography (ERCP) among PSC patients is not well-defined. This study aims to evaluate the association of FISH findings at ERCP with clinical outcomes in patients with PSC. Methods: PSC patients (diagnosed by ERCP or magnetic resonance cholangiopancreatography [MRCP]) seen at our institution from Jan 1, 2010 to June 1, 2018 were identified from an existing institutional review board approved prospective database. Subjects were included if they had a history of PSC and underwent ERCP with FISH evaluation of biliary brushings. Patients with no FISH abnormalities were classified as normal FISH group. Abnormal FISH results were categorized as polysomy/Del 9p21 group (any positive result for polysomy or deletion of 9p21) or trisomy/miscellaneous group. If a patient had more than one ERCP with FISH sampling, the patient was placed into the most abnormal FISH category (polysomy > trisomy/misc > no abnormality). CCA was confirmed by positive tissue biopsy, cytology or evidence of cancer in surgical explant. Mortality data were obtained through electronic health records or national death index. Continuous variables were compared with parametric and non-parametric tests as appropriate, categorical variables were compared using Chi square or Fischer’s exact test. Kaplan Meier curves and log rank test were used to present time to clinical outcome. Results: 84 PSC patients had ERCP and FISH testing, with a median follow up of 84 (IQR, 97.2) months. Tables 1 and 2 show characteristics of normal FISH (N= 18) and abnormal FISH (N= 66) groups. At follow up, the abnormal FISH group had 10 cases of CCA, 1 case of hepatocellular cancer, whereas the normal FISH group had no cancers. Figure 1 shows that the polysomy/deletion 9p21 deletion group had significantly (p = 0.04) worse hepatobiliary cancer free survival compared to the other groups. Discussion: In patients with PSC who underwent ERCP with FISH sampling for biliary strictures, polysomy and deletion 9p21 on FISH analysis was associated with worse hepatobiliary cancer-free survival compared to other FISH findings. If confirmed in multicenter studies, abnormal FISH with polysomy and deletion 9p21 could be considered as an indication for early liver transplantation in individuals with PSC.
Disclosures: Vijay Are indicated no relevant financial relationships. Raj Vuppalanchi indicated no relevant financial relationships. Gail Vance indicated no relevant financial relationships. Glen Lehman: Cook Medical – Consultant. Evan Fogel indicated no relevant financial relationships. James Watkins indicated no relevant financial relationships. Jeffrey Easler: Boston Scientific – Consultant. Benjamin Bick indicated no relevant financial relationships. Aditya Gutta indicated no relevant financial relationships. Naga Chalasani indicated no relevant financial relationships. Stuart Sherman: Boston Scientific – Consultant. Cook Medical – Consultant. Olympus – Consultant. Mark Gromski: Boston Scientific – Consultant.