Cholecystectomy reduces subsequent cholangiocarcinoma risk in choledocholithiasis patients undergoing endoscopic intervention

Chi-Chih Wang; Ming-Hseng Tseng; Sheng-Wen Wu; Tzu-Wei Yang; Hsuan-Yi Chen; Wen-Wei Sung; Chang-Cheng Su; Yao-Tung Wang; Chun-Che Lin; Ming-Chang Tsai

doi:10.4251/wjgo.v12.i12.1381

Cholecystectomy reduces subsequent cholangiocarcinoma risk in choledocholithiasis patients undergoing endoscopic intervention

World J Gastrointest Oncol. 2020 Dec 15;12(12):1381-1393. doi: 10.4251/wjgo.v12.i12.1381.

Authors

Affiliations

¹ Division of Gastroenterology and Hepatology, Department of Internal Medicine, Chung Shan Medical University Hospital, and Institute of Medicine, School of Medicine, Chung Shan Medical University, Taichung 40201, Taiwan.
² Department of Medical Informatics, Chung Shan Medical University, Taichung 402, Taiwan.
³ Department of Internal Medicine, Chung Shan Medical University Hospital and School of Medicine, Chung Shan Medical University, Taichung 402, Taiwan.
⁴ Department of Urology, Chung Shan Medical University Hospital, and Institute of Medicine, School of Medicine, Chung Shan Medical University, Taichung 40201, Taiwan.
⁵ Division of Pulmonary Medicine, Chung Shan Medical University Hospital, and Institute of Medicine, School of Medicine, Chung Shan Medical University, Taichung 402, Taiwan.
⁶ Department of Internal Medicine, China Medical University Hospital and School of Medicine, China Medical University, Taichung 402, Taiwan.
⁷ Division of Gastroenterology and Hepatology, Department of Internal Medicine, Chung Shan Medical University Hospital, and Institute of Medicine, School of Medicine, Chung Shan Medical University, Taichung 40201, Taiwan. tsaimc1110@gmail.com.

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.