Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2020 Dec 15;12(12):1381-1393.
doi: 10.4251/wjgo.v12.i12.1381.

Cholecystectomy reduces subsequent cholangiocarcinoma risk in choledocholithiasis patients undergoing endoscopic intervention

Chi-Chih Wang  1 , Ming-Hseng Tseng  2 , Sheng-Wen Wu  3 , Tzu-Wei Yang  1 , Hsuan-Yi Chen  1 , Wen-Wei Sung  4 , Chang-Cheng Su  1 , Yao-Tung Wang  5 , Chun-Che Lin  6 , Ming-Chang Tsai  7
Affiliations

Cholecystectomy reduces subsequent cholangiocarcinoma risk in choledocholithiasis patients undergoing endoscopic intervention

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

Abstract

Background: Cholangiocarcinoma is a disease with a high mortality rate. Our previous study revealed that cholelithiasis patients who undergo endoscopic sphincterotomy (ES)/endoscopic papillary balloon dilatation are at a higher risk for subsequent cholangiocarcinoma than cholelithiasis patients who undergo cholecystectomy.

Aim: To clarify the relationship between recurrent biliary events and subsequent cholangiocarcinoma risk in choledocholithiasis patients.

Methods: From one million random cases in the Taiwan National Health Insurance Research Database 2004-2011, we selected symptomatic choledocholithiasis patients older than 18 years who were admitted from January 2005 to December 2009 (study group). Cases for a control group were defined as individuals who had never been diagnosed with cholelithiasis, matched by sex and age in a 1:3 ratio. The study group was further divided into ES/endoscopic papillary balloon dilatation, both ES/endoscopic papillary balloon dilatation and cholecystectomy, and no intervention groups.

Results: We included 2096 choledocholithiasis patients without previous intervention or cholangiocarcinoma. A total of 12 (2.35%), 11 (0.74%), and 1 (1.00%) subsequent cholangiocarcinoma cases were diagnosed among 511 ES/endoscopic papillary balloon dilatation patients, 1485 patients with no intervention, and 100 ES/endoscopic papillary balloon dilatation and cholecystectomy patients, respectively. The incidence rates of recurrent biliary event were 527.79/1000 person-years and 286.69/1000 person-years in the subsequent cholangiocarcinoma and no cholangiocarcinoma group, showing a high correlation between subsequent cholangiocarcinoma risk and recurrent biliary events.

Conclusion: Choledocholithiasis patients who undergo further cholecystectomy after ES/endoscopic papillary balloon dilatation have decreased subsequent cholangiocarcinoma risk due to reduced recurrent biliary events.

Keywords: Cholangiocarcinoma; Cholecystectomy; Endoscopic papillary balloon dilatation; Endoscopic sphincterotomy; Recurrent biliary events.

PubMed Disclaimer

Conflict of interest statement

Conflict-of-interest statement: Chun-Che Lin has received research funding from Chung Shan Medical University Hospital Research program (CSH- 2013-C-032) for national health insurance data collection.

Figures

Figure 1
Figure 1
Case selection flow chart for the one million nationwide representative database. ES: Endoscopic sphincterotomy; EPBD: Endoscopic papillary balloon dilatation; NHIRD: National Health Insurance Research Database.
Figure 2
Figure 2
Cholangiocarcinoma cases diagnosed during different follow-up periods in the endoscopic sphincterotomy/endoscopic papillary balloon dilatation group, endoscopic sphincterotomy/endoscopic papillary balloon dilatation and cholecystectomy group, no intervention group, and normal population. ES: Endoscopic sphincterotomy; EPBD: Endoscopic papillary balloon dilatation; CCY: Cholecystectomy.
Figure 3
Figure 3
Cumulative subsequent cholangiocarcinoma risk in the endoscopic sphincterotomy/endoscopic papillary balloon dilatation group, endoscopic sphincterotomy/endoscopic papillary balloon dilatation and cholecystectomy group, no intervention group, and normal population (The cases of cholangiocarcinoma within 18 mo after index admission were excluded). ES: Endoscopic sphincterotomy; EPBD: Endoscopic papillary balloon dilatation; CCY: Cholecystectomy.
See this image and copyright information in PMC

References

    1. Chaiteerakij R, Pan-Ngum W, Poovorawan K, Soonthornworasiri N, Treeprasertsuk S, Phaosawasdi K. Characteristics and outcomes of cholangiocarcinoma by region in Thailand: A nationwide study. World J Gastroenterol. 2017;23:7160–7167. - PMC - PubMed
    1. Treeprasertsuk S, Poovorawan K, Soonthornworasiri N, Chaiteerakij R, Thanapirom K, Mairiang P, Sawadpanich K, Sonsiri K, Mahachai V, Phaosawasdi K. A significant cancer burden and high mortality of intrahepatic cholangiocarcinoma in Thailand: a nationwide database study. BMC Gastroenterol. 2017;17:3. - PMC - PubMed
    1. Wang CC, Tsai MC, Sung WW, Yang TW, Chen HY, Wang YT, Su CC, Tseng MH, Lin CC. Risk of cholangiocarcinoma in patients undergoing therapeutic endoscopic retrograde cholangiopancreatography or cholecystectomy: A population based study. World J Gastrointest Oncol. 2019;11:238–249. - PMC - PubMed
    1. Welzel TM, McGlynn KA, Hsing AW, O'Brien TR, Pfeiffer RM. Impact of classification of hilar cholangiocarcinomas (Klatskin tumors) on the incidence of intra- and extrahepatic cholangiocarcinoma in the United States. J Natl Cancer Inst. 2006;98:873–875. - PubMed
    1. Patel T. Worldwide trends in mortality from biliary tract malignancies. BMC Cancer. 2002;2:10. - PMC - PubMed