Bret T. Petersen, MD, MASGE

Associate Editor



Bret T. Petersen, MD, MASGE, is Professor of Medicine in the Division of Gastroenterology and Hepatology at the Mayo Clinic in Rochester, Minnesota. His practice is focused in the Mayo Pancreas Clinic and the Advanced Endoscopy Group. His professional interests include pancreatic and biliary diseases, performance and outcomes of ERCP, and delivery of endoscopic services. At Mayo, Dr. Petersen is a past Director of Endoscopy and has served on multiple clinic and foundation committees. He has directed numerous American Society for Gastrointestinal Endoscopy (ASGE) and Mayo courses, particularly related to the performance of ERCP. He has received the Mayo Award for Excellence, GI Fellows Award for Outstanding Teacher, and Department of Medicine Laureate Award (GI), as well as the Master Endoscopist Award of the ASGE. Dr. Petersen is the incoming Secretary for (ASGE) and a past Chair of the Technology and Quality Assurance in Endoscopy committees.



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Scheduled Pursuit of Dominant Strictures in PSC May Be Beneficial

Bret T. Petersen, MD, MASGE reviewing Rupp C, et al. Gut 2019 Mar 25.

In this retrospective study of endoscopic therapy for primary sclerosing cholangitis (PSC), the authors evaluated the outcomes of annual endoscopic surveillance, with serial dilation of identified dominant strictures (DS) until near or total morphological resolution was demonstrated, compared with endoscopic assessment and intervention based on symptoms and labs alone. Over a 30-year period, 133 patients (46.5%) with PSC chose annual endoscopic surveillance plus therapy for identified DS, while 153 (53.5%) opted for annual clinical follow-up with intervention only for symptomatic decline, pain, or increasing cholestasis. At a mean of 9.9 years follow-up, the transplant-free survival rates (51% vs 29.3%; p<0.001) and median transplant-free survival durations (17.9 vs 15.2 years; log-rank: p=0.008) were greater in those opting for scheduled surveillance and intervention. This benefit was identified only in the 63% of patients with initial or subsequently identified DS (17.8 vs 11.1 years; p<0.001). Transplant-free survival correlated with presence of IBD, higher Mayo Risk Score, and nonadherence to scheduled endoscopy.

Short-term endoscopic therapy employing dilation with or without stent placement for symptomatic dominant strictures related to PSC is generally accepted as beneficial, based upon retrospective studies. This study suggests more aggressive surveillance for subclinical stricturing, with subsequent therapy if identified, may provide substantial benefit against symptomatic cholangitis or progression to liver failure. The risk:benefit ratio and cost considerations of serial endoscopic cholangiography studies are not yet clear, and alternative means of identifying such lesions would seem critical. Perhaps simply more aggressive response to MRCP findings, independent of clinical symptoms or lab abnormalities, would identify and benefit the same patient population. Prospective surveillance studies appear indicated.


Rupp C, Hippchen T, Bruckner T, et al. Effect of scheduled endoscopic dilatation of dominant strictures on outcome in patients with primary sclerosing cholangitis. Gut 2019 Mar 25. (Epub ahead of print)  (