Sigurd Breder

• Vedeld, Hege Marie; Breder, Sigurd; Pharo, Heidi; Brodal, Hans Petter; Adolfsen, Evy Marie & Brandt-Winge, Sara [Show all 18 contributors for this article] (2026). Accurate detection of cholangiocarcinoma in primary sclerosing cholangitis using DNA methylation biomarkers in bile and plasma. JHEP Reports. 8(8), p. 101876–101876. doi: 10.1016/j.jhepr.2026.101876. Full text in Research Archive
• Breder, Sigurd; Wang, Benny; Villard, Christina; Båve, Aiva; Lindström-Älgå, Lina & Eide, Emma [Show all 15 contributors for this article] (2026). Liver transplantation in primary sclerosing cholangitis with hepatobiliary neoplasia: survival outcomes and impact of diagnostic uncertainty. Scandinavian Journal of Gastroenterology. ISSN 0036-5521. p. 1–12. doi: 10.1080/00365521.2026.2709611. Full text in Research Archive
• Breder, Sigurd; Villard, Christina; Eide, Emma; Wang, Benny; Engesæter, Lise Katrine & Reims, Henrik Mikael [Show all 15 contributors for this article] (2025). A retrospective evaluation of preemptive liver transplantation for bile duct dysplasia in primary sclerosing cholangitis: Balancing risks and benefits. JHEP Reports. 7(12), p. 1–11. doi: 10.1016/j.jhepr.2025.101598. Full text in Research Archive Show summary

  Background & Aims Liver transplantation (LT) to prevent cholangiocarcinoma (CCA) in individuals with primary sclerosing cholangitis (PSC) and bile duct dysplasia was introduced in Norway and Sweden in the early 2000s. We aimed to evaluate this practice to potentially improve future selection of candidates for LT. Methods We conducted a retrospective study of 512 adults with PSC who underwent first-time LT between 2000–2021 at Oslo and Karolinska University Hospitals. Pre-LT findings in bile duct brush cytology and/or biopsy of low-grade dysplasia (LGD) and high-grade dysplasia (HGD) were compared with histological findings in the explanted livers and survival rates were assessed. Results Bile duct dysplasia, low-grade (LGD) or high-grade (HGD), was the primary LT indication in 17% (88/512). Among individuals transplanted for LGD, only 10% (3/29) had HGD or CCA in the explant, compared to 48% (28/59) in the HGD group. No neoplasia was found in 42% (12/29) of LGD and 24% (14/59) of HGD cases, meaning nearly one-third of patients transplanted for suspected bile duct dysplasia had no histological evidence of neoplasia in the explant. Five-year post-transplant survival according to the explant histology was 95% for no neoplasia, 89% for LGD, 85% for HGD, decreasing to 33% in those with CCA in the explant. Conclusions While favorable survival in confirmed dysplasia supports the role of preemptive LT, the absence of neoplasia in a substantial proportion of explants, particularly in suspected LGD, calls for a cautious, individualized approach. LT appears more clearly justified in accurately diagnosed HGD, given its strong association with early malignancy and the poor prognosis of advanced CCA. Impact and implications Individuals with primary sclerosing cholangitis (PSC) are at increased risk of developing bile duct cancer. In precancerous stages (bile duct dysplasia), liver transplantation (LT) may prevent progression to advanced, incurable cancer. In our evaluation of 512 patients with PSC who underwent LT, we found that the low diagnostic accuracy and unpredictable detection of mild dysplasia support a cautious, individualized approach to LT in precancerous stages of PSC, while more advanced dysplasia remains a valid indication for LT.

• Mikalsen, Ina; Breder, Sigurd; Medhus, Asle Wilhelm; Folseraas, Trine; Aabakken, Lars & Ånonsen, Kim Vidar (2023). ERCP for the initial management of malignant biliary obstruction–real world data on 596 procedures. Scandinavian Journal of Gastroenterology. ISSN 0036-5521. doi: 10.1080/00365521.2023.2282375. Full text in Research Archive Show summary

  Aims To evaluate outcomes of ERCP as first-line management in patients with malignant biliary obstruction (MBO) of all causes and stages, reflecting a real-life setting. Methods Retrospective observational study of patients with ERCP as the first-line management of MBO at Oslo University Hospital between 2015 and 2021. Primary outcome measure was a ≥ 50% decrease from the pre-procedural bilirubin within 30 days after ERCP. Secondary outcome measures were technical success of ERCP, complications and overall mortality. Results A total of 596 patients were included, median age 70 years. ASA score was ≥ III in 67% of patients. The most common cancers causing MBO were pancreatic cancer (52%), metastatic lesions (20%) and cholangiocarcinoma (16%). The primary outcome measure was achieved in 62% of patients. With endoscopic access, overall technical success was 80% with 85% for the distal extrahepatic group, 71% for the perihilar, 40% for the intrahepatic and 53% for multiple level MBOs. Reinterventions were performed in 27% of the patients. Complications occurred in 15% of the patients, including post-ERCP pancreatitis in 9%. Most complications were of minor/moderate severity (81%). Overall mortality was 33% within the first 90 days. Patients deceased by the end of the study period (83%) had median survival of 146 days (range 1–2,582 days). Conclusions ERCP has a high rate of clinical effect and technical success in the management of both distal extrahepatic and perihilar MBO. Our data indicate that ERCP is a valid option in the first-line management of MBO.

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