P3823 - Risk of Colorectal Cancer With Inflammatory Bowel Disease and Primary Sclerosing Cholangitis Compared to Primary Sclerosing Cholangitis Only: A Need for Consensus on Colonoscopy Surveillance Guidelines for PSC Without IBD

Award: Presidential Poster Award

Taranika Sarkar Das, MD¹, Kimberly Ho, ², Jahnavi Udaikumar, MD³, Bryan Chen, ², Olivia Delau, MS², Aasma Shaukat, MD⁴, Ira Jacobson, MD⁴, Raiya Sarwar, MD^4
1NYU Langone Health, Brooklyn, NY; ²NYU Grossman School of Medicine, New York, NY; ³NYU Grossman School of Medicine, Brooklyn, NY; ⁴NYU Langone Health, New York, NY

Introduction: Primary sclerosing cholangitis (PSC) increases risk of colorectal cancer (CRC) in patients with inflammatory bowel disease (IBD), but literature suggesting PSC as an independent risk factor for CRC is scarce. In one report, lifetime CRC risk was 31% with concomitant disease compared to 2% with PSC alone.¹ Annual surveillance colonoscopy is recommended for concomitant disease, while some advocate every 5 years for PSC alone.² We aim to determine if PSC alone is a significant risk factor for CRC, compared to PSC and IBD together.

Methods: A retrospective cohort study between PSC before IBD (PSC-IBD) and PSC-only patients from a tertiary academic medical center was conducted. Adults with IBD diagnosed before PSC or simultaneously as PSC were excluded, to reduce IBD's impact on CRC risk. Data for age, sex, race, diagnosis dates, and colonoscopy findings were collected and reviewed.

Results: 172 patients (32 PSC-IBD (18.6%), 140 PSC-only (81.4%)) were identified from all NYU Langone Health clinical settings between 2000-2022. The mean age was 50.4 and 57.4 years, respectively (p=0.032). The mean years between the development of IBD and PSC was 5.3. Of the patients with IBD, 53.6% were diagnosed with ulcerative colitis (UC) and 46% with Crohn’s disease (CD). 55% of patients in the PSC-IBD group and 61% in the PSC-only group underwent colonoscopy with biopsies. Among patients with PSC-IBD and those with PSC-only, 8 (25%) and 2 (1.43%) patients were diagnosed with CRC, respectively (p=< 0.001) (Table 1). The mean age of CRC diagnosis in the two groups was 44 and 51, while the mean years between CRC diagnosis from onset of PSC were 7.3 and 8.7, respectively, although not statistically significant. A Kaplan Meier curve compares the time to CRC diagnosis between these two groups (Figure 1).

Discussion: Patients with PSC-IBD have a significantly elevated CRC risk of 25%. However, for those with only PSC, the risk reduces to 1.43%, lower than the general population¹. As previously documented, PSC-IBD patients carry an increased CRC risk compared to the general population, while PSC-only patients did not, in this study. Further studies are needed to determine the optimal CRC screening intervals for patients with PSC only.



1. Claessen et al. High lifetime risk of cancer in primary sclerosing cholangitis. Journal of hepatology. 2009;50(1):158-16.

2. Lindor et al. ACG clinical guideline: primary sclerosing cholangitis. Official journal of the American College of Gastroenterology| ACG. 2015;110(5):646-659.



Disclosures:


Taranika Sarkar Das, MD¹, Kimberly Ho, ², Jahnavi Udaikumar, MD³, Bryan Chen, ², Olivia Delau, MS², Aasma Shaukat, MD⁴, Ira Jacobson, MD⁴, Raiya Sarwar, MD⁴. P3823 - Risk of Colorectal Cancer With Inflammatory Bowel Disease and Primary Sclerosing Cholangitis Compared to Primary Sclerosing Cholangitis Only: A Need for Consensus on Colonoscopy Surveillance Guidelines for PSC Without IBD, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.