Kotha Sreelakshmi, Koumoutsos Ioannis, Warner Ben, Theocharidou Eleni, Mawdsley Joel, Berry Philip
Department of Gastroenterology, Guy's and St Thomas' Foundation Trust, London SE1 7EH, United Kingdom.
ILIVER. 2024 Feb 5;3(2):100076. doi: 10.1016/j.iliver.2024.100076. eCollection 2024 Jun.
Primary sclerosing cholangitis (PSC) often co-exists with inflammatory bowel disease (IBD) and together they are associated with increased risk of complications, including cancer (hepatobiliary, colorectal, gallbladder) and death. Guidelines for follow up and surveillance vary, but our local guidelines advise annual surveillance with magnetic resonance cholangiopancreatography (MRCP), colonoscopy and ultrasound (US) (6 monthly if cirrhotic). We aimed to assess the quality of care in our PSC-IBD patients, including adherence to local surveillance guidelines, and resultant detection of complications, before and after the introduction of an integrated PSC and IBD out-patient service.
Data on management of PSC-IBD patients was collected retrospectively before, and prospectively following, the introduction of an integrated service. Descriptive comparisons of diagnoses, adherence to planned surveillance and outcomes were made between cohorts pre- and post-service redesign.
Prior to the service re-design there was significant variability in care and poor adherence to guidelines. Introduction of an integrated PSC-IBD service led to 89 referrals with possible PSC-IBD at 36 months after service re-design. Detailed review led to appropriate identification of 68 PSC-IBD patients. There was significant improvement in surveillance with annual colonoscopy in 90%, MRI/MRCP in 81%, US in 35%, compared to 55%, 55% and 7% respectively in the baseline cohort. This translated to diagnosis and appropriate treatment of colonic dysplasia in 4 patients, colorectal cancer (CRC) in 4 patients and cholangiocarcinoma (CCA) in 2 patients.
Establishment of an integrated out-patient service for PSC-IBD patients results in better compliance with guidelines, effective detection of complications, and appropriate management.
原发性硬化性胆管炎（PSC）常与炎症性肠病（IBD）并存，二者共同导致包括癌症（肝胆、结肠、胆囊）和死亡在内的并发症风险增加。随访和监测指南各不相同，但我们当地的指南建议每年进行磁共振胰胆管造影（MRCP）、结肠镜检查和超声（US）监测（肝硬化患者每6个月监测一次）。我们旨在评估在设立综合PSC和IBD门诊服务前后，我们的PSC-IBD患者的护理质量，包括对当地监测指南的遵守情况以及并发症的检出情况。
回顾性收集设立综合服务之前以及前瞻性收集设立之后PSC-IBD患者的管理数据。对服务重新设计前后队列的诊断、对计划监测的遵守情况和结果进行描述性比较。
在服务重新设计之前，护理存在显著差异，对指南的遵守情况较差。设立综合PSC-IBD服务后，在服务重新设计36个月时有89例疑似PSC-IBD患者前来转诊。详细审查后正确识别出68例PSC-IBD患者。与基线队列中分别为55%、55%和7%相比，年度结肠镜检查监测率提高到90%，MRI/MRCP提高到81%，US提高到35%。这使得4例患者的结肠发育异常、4例患者的结直肠癌（CRC）和2例患者的胆管癌（CCA）得以诊断并得到适当治疗。
为PSC-IBD患者设立综合门诊服务可提高对指南的依从性，有效检测并发症并进行适当管理。
