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©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Oncol. Mar 15, 2019; 11(3): 238-249
Published online Mar 15, 2019. 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, Ming-Chang Tsai, Wen-Wei Sung, Tzu-Wei Yang, Hsuan-Yi Chen, Yao-Tung Wang, Chang-Cheng Su, Ming-Hseng Tseng, Chun-Che Lin
Chi-Chih Wang, Ming-Chang Tsai, Wen-Wei Sung, Yao-Tung Wang, Chun-Che Lin, Institute of Medicine, Chung Shan Medical University, Taichung 40201, Taiwan
Chi-Chih Wang, Ming-Chang Tsai, Wen-Wei Sung, Tzu-Wei Yang, Hsuan-Yi Chen, Yao-Tung Wang, Chun-Che Lin, School of Medicine, Chung Shan Medical University, Taichung 40201, Taiwan
Chi-Chih Wang, Ming-Chang Tsai, Tzu-Wei Yang, Hsuan-Yi Chen, Chang-Cheng Su, Chun-Che Lin, Division of Gastroenterology and Hepatology, Department of Internal Medicine, Chung Shan Medical University Hospital, Taichung 40201, Taiwan
Wen-Wei Sung, Department of Urology, Chung Shan Medical University Hospital, Taichung 40201, Taiwan
Tzu-Wei Yang, Institute and Department of Biological Science and Technology, National Chiao Tung University, Hsinchu 30010, Taiwan
Yao-Tung Wang, Division of Pulmonary Medicine, Department of Internal Medicine, Chung Shan Medical University Hospital, Taichung 40201, Taiwan
Ming-Hseng Tseng, Department of Medical Informatics, Chung Shan Medical University, Taichung 40201, Taiwan
Ming-Hseng Tseng, Information Technology Office, Chung Shan Medical University Hospital, Taichung 40201, Taiwan
Author contributions: Tseng MH and Lin CC contributed equally to this manuscript; Wang CC, Tseng MH and Sung WW contributed to conception and design; Tseng MH contributed to acquisition of data; Tsai MC, Wang CC, Wang YT and Chen HY contributed to analysis and interpretation of data; Wang CC, Yang TW and Chen HY contributed to drafting of the manuscript; Yang TW, Sung WW and Lin CC contributed to critical revision of the manuscript; Tsai MC, Sung WW and Su CC contributed to statistical analysis; Tseng MH and Lin CC contributed to supervision.
Supported by Chung Shan Medical University Hospital research program, Taichung, Taiwan, No. CSH- 2013-C-032.
Institutional review board statement: This study was approved by the Institutional Review Board of Chung Shan Medical University Hospital, Taiwan.
Informed consent statement: The Institutional Review Board waved the need of informed consent in this study as it is a retrospective study based on the National Health Insurance Research Database.
Conflict-of-interest statement: None.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.
Open-Access: This article is an open-access article which 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: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Chun-Che Lin, MD, PhD, Attending Doctor, Chief Doctor, Doctor, Professor, Division of Gastroenterology and Hepatology, Department of Internal Medicine, Chung Shan Medical University Hospital, No.110, Sec.1, Jianguo N.Rd., Taichung 40201, Taiwan. cshy333@csh.org.tw
Telephone: +886-424730022-11603 Fax: +886-423248130
Received: October 25, 2018
Peer-review started: October 25, 2018
First decision: December 10, 2018
Revised: January 16, 2019
Accepted: January 29, 2019
Article in press: January 30, 2019
Published online: March 15, 2019
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.
Core tip: There are many risk factors well demonstrated in cholangiocarcinoma, but the impacts of advanced biliary interventions, like endoscopic sphincterotomy (ES), endoscopic papillary balloon dilatation (EPBD) and cholecystectomy, are inconsistence in previous literature. We tried to evaluate the subsequent cholangiocarcinoma risk in cholelithiasis patients who underwent ES, EPBD and cholecystectomy. Cholecystectomy can reduce the incidence of subsequent cholangiocarcinoma, while cholelithiasis patients underwent ES/EPBD are in a huge risk of subsequent cholangiocarcinoma in our database study.
