You are here

  • Home
  • Online First
  • Guidelines Development Group for the British Society of Gastroenterology guidelines for the diagnosis and management of cholangiocarcinoma

Article Text

Article menu

Download PDFPDF

Letter
Guidelines Development Group for the British Society of Gastroenterology guidelines for the diagnosis and management of cholangiocarcinoma
  1. Shahid A Khan1,
  2. Simon M Rushbrook2,
  3. Timothy James Kendall3,4,
  4. Yoh Zen5,
  5. Raneem Albazaz6,
  6. Prakash Manoharan7,
  7. Stephen P Pereira8,
  8. Richard Sturgess9,
  9. Brian R Davidson10,
  10. Hassan Z Malik11,
  11. Derek Manas12,
  12. Nigel Heaton13,
  13. K Raj Prasad14,
  14. Juan W Valle15,
  15. Rebecca Goody16,
  16. Maria Hawkins8,17,
  17. Wendy Prentice18,
  18. Helen Morement19,
  19. Martine Walmsley20,
  20. John Bridgewater21
  1. 1Hepatology and Gastroenterology Section, Department of Medicine, Imperial College London, London, UK
  2. 2Department of Hepatology, Norfolk and Norwich University Hospitals NHS Trust, Norwich, UK
  3. 3University of Edinburgh MRC Centre for Inflammation Research, Edinburgh, UK
  4. 4Division of Pathology, University of Edinburgh, Edinburgh, UK
  5. 5King's College London, London, UK
  6. 6Department of Radiology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
  7. 7Christie Hospital, Manchester, UK
  8. 8University College London, London, UK
  9. 9Digestive Diseases Unit, Aintree University Hospitals NHS Foundation Trust, Liverpool, UK
  10. 10Surgery, Royal Free Campus, UCL Medical School, London, UK
  11. 11Surgery, University Hospital Aintree, Liverpool, UK
  12. 12Newcastle University, Newcastle upon Tyne, UK
  13. 13Department of Hepatobiliary and Pancreatic Surgery, King’s College London, London, UK
  14. 14John Goligher Colorectal Unit, St. James University Hospital, Leeds, UK
  15. 15Medical Oncology, The Christie NHS Foundation Trust/University of Manchester, Manchester, UK
  16. 16St James's University Hospital, Leeds, UK
  17. 17Department of Medical Physics and Biomedical Engineering, University College London, London, UK
  18. 18King's College Hospital, London, UK
  19. 19AMMF, Essex, UK
  20. 20Chair of Trustees PSC Support, Didcot, UK
  21. 21Department of Oncology, UCL Cancer Institute, University College London, London, UK
  1. Correspondence to Dr Shahid A Khan, Hepatology and Gastroenterology Section, Department of Medicine, Imperial College London, London, UK; shahid.khan{at}imperial.ac.uk

https://doi.org/10.1136/gutjnl-2024-333359

Statistics from Altmetric.com

    Request Permissions

    If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

    We have recently published in Gut the British Society of Gastroenterology (BSG) guidelines for the diagnosis and management of cholangiocarcinoma.1 In the guidelines we recommended cisplatin plus gemcitabine (CisGem) chemotherapy as first-line systemic treatment in patients with advanced biliary tract cancer (BTC), and that immunotherapy may be added to CisGem chemotherapy if approved and available (Recommendation 39). A few weeks after the guidelines were published, the UK’s National Institute for Health and Care Excellence approved and recommended the use of durvalumab plus gemcitabine and cisplatin as an option for treating locally advanced, unresectable or metastatic BTC in adults,2 and we believe this triple combination should be first line. This was also approved by the Scottish Medicines Consortium in November 2023 and thus represents a new standard of care for cholangiocarcinoma treatment, but this is not specifically mentioned in the latest published BSG guidelines.

    Furthermore, at the time of publication of the BSG guidelines, there was little consensus as to the frequency of clinical follow-up following resection for cholangiocarcinoma. However, as patients are at risk of complications related to treatment, as well as the high rate of cholangiocarcinoma recurrence, follow-up is carried out in practice by most centres. Following the recent publication of the ESMO Guidelines Committee’s Clinical Practice Guideline for diagnosis, treatment and follow-up of BTC,3 we also now recommend that follow-up is undertaken following cholangiocarcinoma-resection, and this may consist of 3 to 6-monthly visits during the first 2 years and 6 to 12-monthly visits for up to 5 years, or as clinically indicated. A combination of clinical examination, laboratory investigations, tumour markers and CT scan of the thorax, abdomen and pelvis may be appropriate.3

    These updates have been endorsed by all authors on the guideline writing panel as well as the Liver Committee of the BSG. We request that these important updates, via this letter, be linked to the online BSG guidelines for the diagnosis and management of cholangiocarcinoma.

    Ethics statements

    Patient consent for publication

    Ethics approval

    Not applicable.

    References

    1. ↵
      1. Rushbrook SM,
      2. Kendall TJ,
      3. Zen Y, et al
      . British Society of Gastroenterology guidelines for the diagnosis and management of cholangiocarcinoma. Gut 2023;73:16–46. doi:10.1136/gutjnl-2023-330029
      OpenUrl
    2. ↵
      1. NICE
      . Durvalumab with gemcitabine and cisplatin for treating unresectable or advanced biliary tract cancer (TA944). 2024. Available: https://www.nice.org.uk/guidance/ta944/resources/durvalumab-with-gemcitabine-and-cisplatin-for-treating-unresectable-or-advanced-biliary-tract-cancer-pdf-82615668536005
    3. ↵
      1. Vogel A,
      2. Bridgewater J,
      3. Edeline J, et al
      . Biliary tract cancer: ESMO Clinical Practice Guideline for diagnosis, treatment and follow-up. Ann Oncol 2023;34:127–40. doi:10.1016/j.annonc.2022.10.506
      OpenUrl

    Footnotes

    • Contributors SAK is the senior author and guarantor.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; internally peer reviewed.