P1061 - Predictors of Long-Term Outcomes of Primary Sclerosing Cholangitis Based on Cholangioscopic Features

Bernardo Guevara, MD¹, Stephanie L. Yan, MD¹, Jeffrey Fine, MPH², Sooraj Tejaswi, MD, MSPH, FACG³, Machelle Wilson, PhD^2
1University of California Davis, Sacramento, CA; ²University of California Davis Medical Center, Davis, CA; ³University of California Davis Medical Center, Sacramento, CA

Introduction: PSC is a fibroinflammatory disease that can progress to liver failure, malignancy, or both. ERCP aids in the evaluation and dilation of dominant strictures. Cholangioscopy enables the categorization of mucosal disease activity into fibrostenotic or inflammatory phenotypes. We hypothesize that endoscopic balloon dilation leads to clinical and biochemical improvements in fibrostenotic disease but not with an actively inflamed duct. Knowledge of the disease phenotype can limit unnecessary ERCPs. We compared the long-term clinical outcomes and total # of ERCPs in patients with fibrostenotic and inflammatory phenotypes.

Methods: A retrospective review of 19 PSC patients who underwent cholangioscopy between Jan 2015 to Dec 2020, examined demographics, PSC duration, LFTs at defined intervals up to 36 mos., ERCP indications (cholangitis, imaging, LFTs, pain, pruritis, fatigue, jaundice), and co-existing IBD. PSC was classified as fibrostenotic and inflamed phenotypes based on cholangioscopic exam. Outcomes were classified as stable vs. not stable (cholangiocarcinoma or prompting a transplant evaluation). We compared outcomes, % change in cholestatic markers, and # of ERCPs between disease groups by univariate and multivariate regression analyses.

Results: Majority of the patients (10/19) were noted to clinically deteriorate over time. The cholangioscopic disease classification was not prognostic, but 7/14 patients with fibrostenotic phenotypes remained stable, compared to 2/5 in the inflamed phenotype group. Cholangioscopic classification did not predict % change in bilirubin and ALP over time. Age, sex, BMI, PSC duration, % change in bilirubin and ALP levels were not prognostic either. Non-white patients had a worse prognosis (p=0.04). Co-existing IBD was associated with a better prognosis (p=0.01). There was no statistical difference in the # of ERCPs needed between the fibrostenotic (mean 1.6) vs. inflamed (mean 4.2) groups.

Discussion: Cholangioscopic classification of disease activity in PSC into fibrostenotic vs. inflamed phenotypes was not prognostic in our pilot study. The small differences we noted (worsening disease in 50% fibrostenotic vs. 60% in the inflamed phenotype, and 2x higher mean ERCPs in inflamed phenotype) could be a significant finding in a larger study sample followed over a longer period of time. The increasing use of cholangioscopy for PSC could lead to a meaningful form of prognostication similar to endoscopic disease activity assessments for inflammatory bowel disease.



Disclosures:


Bernardo Guevara, MD¹, Stephanie L. Yan, MD¹, Jeffrey Fine, MPH², Sooraj Tejaswi, MD, MSPH, FACG³, Machelle Wilson, PhD². P1061 - Predictors of Long-Term Outcomes of Primary Sclerosing Cholangitis Based on Cholangioscopic Features, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.