Colonoscopy surveillance in primary sclerosing cholangitis patients during the COVID-19 pandemic - a tertiary centre experience

Introduction Primary sclerosing cholangitis (PSC), with or without inflammatory bowel disease (IBD), confers a markedly increased risk of colorectal cancer (CRC). BSG recommends annual and 5-yearly surveillance colonoscopies for PSC-IBD and PSC-only patients respectively. The COVID-19 pandemic introduced disruptions to surveillance colonoscopy provision. We evaluated adherence to CRC surveillance guidelines in the Imperial College Healthcare NHS Trust PSC cohort before, during and after the peak of the COVID-19 pandemic. Methods This retrospective study included adults with established PSC, with or without IBD. Patients with gastrointestinal cancer at index diagnosis, those who died during follow-up or those with prior colectomy were excluded. Adherence to BSG guidelines for surveillance colonoscopies in PSC-IBD patients was assessed in three time periods: pre-pandemic (01/09/18–29/02/20), peak-pandemic (01/03/20–31/03/21) and post-peak (01/04/21–30/09/22). PSC-only patients were assessed for one surveillance colonoscopy between 01/10/17–30/09/22. Medical records were reviewed for documentation of reasons for non-adherence. Results 73 patients were included (54 PSC-IBD, 19 PSC-only). of the PSC-IBD patients, colonoscopy surveillance was achieved pre-, peak- and post-peak pandemic in 57% (n=31), 41% (n=22) and 65% (n=35) respectively. After considering mitigating factors, adherence was 85% (n=46), 83% (n=45) and 91% (n=49) respectively. of the 32 missed peak-pandemic colonoscopies, 13 patients also missed surveillance pre- and post-peak pandemic (figure 1A), 17 patients subsequently had post-peak surveillance (figure 1B) and two patients missed post-peak surveillance (figure 1C). In total, 23 missed colonoscopies were mitigated; nine explicitly owing to COVID-19, nine patients moved Trust and five due to patient choice. In all, 74% (n=40) of PSC-IBD patients either received surveillance colonoscopies throughout the entire study period (n=15) or had valid documented mitigating reasons for all missed procedures (n=25). 68% (n=13) of PSC-only patients underwent at least one 5-yearly surveillance colonoscopy peri-pandemic as per guidelines. Of the remaining 32% (n=6), three cases were mitigated (two patients moved Trust post-liver transplant, one owing to patient choice). No CRC cases were detected in the PSC-IBD or PSC-only groups. Conclusions Despite COVID-19 disruptions to surveillance colonoscopies, most PSC patients received appropriate surveillance to date. Further efforts should be made to resolve the surveillance procedure backlog in this high-risk group.