Retrospective Study
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Feb 16, 2024; 12(5): 913-921
Published online Feb 16, 2024. doi: 10.12998/wjcc.v12.i5.913
Removal of intrahepatic bile duct stone could reduce the risk of cholangiocarcinoma: A single-center retrospective study in South Korea
Tae In Kim, Sung Yong Han, Jonghyun Lee, Dong Uk Kim
Tae In Kim, Sung Yong Han, Jonghyun Lee, Dong Uk Kim, Division of Gastroenterology, Biomedical Research Institute, Pusan National University Hospital, Busan 49241, South Korea
Sung Yong Han, Dong Uk Kim, Department of Internal Medicine, Pusan National University, College of Medicine, Yangsan 50612, South Korea
Author contributions: Kim TI, Han SY, Lee J, and Kim DU contributed to the design, writing and data analysis of the manuscript.
Supported by a grant from the National R&D Program for Cancer Control, Ministry of Health and Welfare, Republic of Korea, No. HA20C0009.
Institutional review board statement: The study was reviewed and approved by the Biomedical Research Institute, Pusan National University Hospital, Institutional Review Board (Approval No. 2103-010-101).
Informed consent statement: We have no signed informed consent because this is a retrospective study and we analyzed medical records of patients in our center. We obtained a consent exemption for our research.
Conflict-of-interest statement: Dr. Kim reports grants from the National R&D Program for Cancer Control, Ministry of Health and Welfare, Republic of Korea, during the conduct of the study.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non-Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Dong Uk Kim, MD, PhD, Adjunct Associate Professor, Division of Gastroenterology, Biomedical Research Institute, Pusan National University Hospital, 179 Gudeok-ro, Seo-gu, Busan 49241, South Korea. amlm3@hanmail.net
Received: October 18, 2023
Peer-review started: October 18, 2023
First decision: November 22, 2023
Revised: December 6, 2023
Accepted: January 15, 2024
Article in press: January 15, 2024
Published online: February 16, 2024
Abstract
BACKGROUND

Intrahepatic duct (IHD) stones are among the most important risk factors for cholangiocarcinoma (CCC). Approximately 10% of patients with IHD stones develop CCC; however, there are limited studies regarding the effect of IHD stone removal on CCC development.

AIM

To investigate the association between IHD stone removal and CCC development.

METHODS

We retrospectively analyzed 397 patients with IHD stones at a tertiary referral center between January 2011 and December 2020.

RESULTS

CCC occurred in 36 of the 397 enrolled patients. In univariate analysis, chronic hepatitis B infection (11.1% vs 3.0%, P = 0.03), carbohydrate antigen 19-9 (CA19-9, 176.00 vs 11.96 II/mL, P = 0.010), stone located in left or both lobes (86.1% vs 70.1%, P = 0.042), focal atrophy (52.8% vs 26.9%, P = 0.001), duct stricture (47.2% vs 24.9%, P = 0.004), and removal status of IHD stone (33.3% vs 63.2%, P < 0.001) were significantly different between IHD stone patients with and without CCC. In the multivariate analysis, CA19-9 > upper normal limit, carcinoembryonic antigen > upper normal limit, stones located in the left or both lobes, focal atrophy, and complete removal of IHD stones without recurrence were independent factors influencing CCC development. However, the type of removal method was not associated with CCC risk.

CONCLUSION

Complete removal of IHD stones without recurrence could reduce CCC risk.

Keywords: Intrahepatic bile duct stone, Cholangiocarcinoma, Percutaneous transhepatic cholangioscopy, Endoscopic retrograde cholangiopancreatography, Carbohydrate antigen 19-9

Core Tip: It is well known that intrahepatic duct (IHD) stones are the most important risk factors for cholangiocarcinoma (CCC), but there are limited studies regarding the effect of IHD stone removal on CCC development. It has been reported that remnant stones after percutaneous transhepatic cholangioscopy could be a risk factor for CCC, but the effect of recurrence after complete removal of stones on CCC is unclear. Based on this, we investigated the association of IHD stone removal and CCC development.