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. 2019 Mar 15;11(3):238-249.
doi: 10.4251/wjgo.v11.i3.238.

Risk of cholangiocarcinoma in patients undergoing therapeutic endoscopic retrograde cholangiopancreatography or cholecystectomy: A population based study

Chi-Chih Wang  1 , Ming-Chang Tsai  1 , Wen-Wei Sung  1 , Tzu-Wei Yang  2 , Hsuan-Yi Chen  2 , Yao-Tung Wang  1 , Chang-Cheng Su  3 , Ming-Hseng Tseng  4 , Chun-Che Lin  1
Affiliations

Risk of cholangiocarcinoma in patients undergoing therapeutic endoscopic retrograde cholangiopancreatography or cholecystectomy: A population based study

Chi-Chih Wang et al. World J Gastrointest Oncol. .

Abstract

Background: Cholangiocarcinoma is a highly lethal disease that had been underestimated in the past two decades. Many risk factors are well documented for in cholangiocarcinoma, but the impacts of advanced biliary interventions, like endoscopic sphincterotomy (ES), endoscopic papillary balloon dilatation (EPBD), and cholecystectomy, are inconsistent in the previous literature.

Aim: To clarify the risks of cholangiocarcinoma after ES/EPBD, cholecystectomy or no intervention for cholelithiasis using the National Health Insurance Research Database (NHIRD).

Methods: From data of NHIRD 2004-2011 in Taiwan, we selected 7938 cholelithiasis cases as well as 23814 control group cases (matched by sex and age in a 1:3 ratio). We compared the previous risk factors of cholangiocarcinoma and cholangiocarcinoma rate in the cholelithiasis and control groups. The incidences of total and subsequent cholangiocarcinoma were calculated in ES/EPBD patients, cholecystectomy patients, cholelithiasis patients without intervention, and groups from the normal population.

Results: In total, 537 cases underwent ES/EPBD, 1743 cases underwent cholecystectomy, and 5658 cholelithiasis cases had no intervention. Eleven (2.05%), 37 (0.65%), and 7 (0.40%) subsequent cholangiocarcinoma cases were diagnosed in the ES/EPBD, no intervention, and cholecystectomy groups, respectively, and the odds ratio for subsequent cholangiocarcinoma was 3.13 in the ES/EPBD group and 0.61 in the cholecystectomy group when compared with the no intervention group.

Conclusion: In conclusion, symptomatic cholelithiasis patients who undergo cholecystectomy can reduce the incidence of subsequent cholangiocarcinoma, while cholelithiasis patients who undergo ES/EPBD are at a great risk of subsequent cholangiocarcinoma according to our findings.

Keywords: Cholangiocarcinoma; Cholecystectomy; Endoscopic papillary balloon dilatation; Endoscopic sphincterotomy.

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Conflict of interest statement

Conflict-of-interest statement: None.

Figures

Figure 1
Figure 1
Case selection flow chart of one million nationwide representative data base. ES/EPBD: Endoscopic sphincterotomy/endoscopic papillary balloon dilatation; NHIRD: National Health Insurance Research Database.
Figure 2
Figure 2
Cumulative risk of cholangiocarcinoma. The cases of cholangiocarcinoma within 6 mo after the therapeutic procedure or the diagnosis of cholelithiasis were excluded. ES/EPBD: Endoscopic sphincterotomy/endoscopic papillary balloon dilatation.
See this image and copyright information in PMC

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