Copyright
©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
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
Chi-Chih Wang, Tzu-Wei Yang, Hsuan-Yi Chen, Chang-Cheng Su, Ming-Chang Tsai, 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
Ming-Hseng Tseng, Department of Medical Informatics, Chung Shan Medical University, Taichung 402, Taiwan
Sheng-Wen Wu, Department of Internal Medicine, Chung Shan Medical University Hospital and School of Medicine, Chung Shan Medical University, Taichung 402, Taiwan
Wen-Wei Sung, Department of Urology, Chung Shan Medical University Hospital, and Institute of Medicine, School of Medicine, Chung Shan Medical University, Taichung 40201, Taiwan
Yao-Tung Wang, Division of Pulmonary Medicine, Chung Shan Medical University Hospital, and Institute of Medicine, School of Medicine, Chung Shan Medical University, Taichung 402, Taiwan
Chun-Che Lin, Department of Internal Medicine, China Medical University Hospital and School of Medicine, China Medical University, Taichung 402, Taiwan
Author contributions: Wang CC and Tsai MC contributed to study conception and design; Tseng MH and Wu SW contributed to acquisition of the data; Wang CC, Wang YT, and Wu SW contributed to analysis and interpretation of the data; Wang CC, Yang TW, and Chen HY contributed to drafting of the manuscript; Tsai MC, Yang TW, Sung WW, and Lin CC contributed to critical revision of the manuscript; Tseng MH, Tsai MC, and Su CC contributed to statistical analysis; Tsai MC contributed to supervision.
Supported by Chung Shan Medical University Hospital Research program, No. CSH-2013-C-032.
Institutional review board statement: This study was approved by the Institutional Review Board (IRB) of Chung Shan Medical University Hospital, Taiwan. All methods were performed in accordance with the relevant guidelines and regulations and under surveillance by the IRB of Chung Shan Medical University Hospital.
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.
Data sharing statement: No additional data are available.
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 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 NonCommercial (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: Ming-Chang Tsai, MD, PhD, Assistant Professor, Doctor, Division of Gastroenterology and Hepatology, Department of Internal Medicine, Chung Shan Medical University Hospital, No. 110, Sec. 1, Jianguo N. Road, South District, Taichung 402, Taiwan. tsaimc1110@gmail.com
Received: July 4, 2020
Peer-review started: July 4, 2020
First decision: September 18, 2020
Revised: September 26, 2020
Accepted: October 30, 2020
Article in press: October 30, 2020
Published online: December 15, 2020
ARTICLE HIGHLIGHTS
Research background
Our previous study revealed that cholelithiasis patients who undergo endoscopic sphincterotomy/endoscopic papillary balloon dilatation (ES/EPBD) are at a greater risk for subsequent cholangiocarcinoma, while cholelithiasis patients who undergo cholecystectomy (CCY) have a much lower risk for subsequent cholangiocarcinoma.
Research motivation
Because of problems in prior study’s design, we could not identify whether different inflammation sites or CCY-reduced recurrent biliary events (RBEs) influenced the subsequent cholangiocarcinoma risk in cholelithiasis patients.
Research objectives
To evaluate the relationships of recurrent biliary events with subsequent cholangiocarcinoma risk.
Research methods
We selected symptomatic choledocholithiasis patients older than 18 years who were admitted from January 2005 to December 2009 from one million random samples in the National Health Insurance Research Database of Taiwan.
Research results
This study showed that choledocholithiasis patients who underwent further CCY after ES/EPBD can reduce subsequent cholangiocarcinoma risk from 2.35% to 1%. And the subsequent cholangiocarcinoma risks had a good correlation with RBEs in our study. Choledocholithiasis patients who have undergone an ES/EPBD intervention without further CCY had a 25–26-fold higher subsequent cholangiocarcinoma risk than the normal population.
Research conclusions
Further CCY in ES/EPBD patients decreases subsequent cholangiocarcinoma risk by reducing RBEs.
Research perspectives
This study not only showed different subsequent cholangiocarcinoma risks in the ES/EPBD, ES/EPBD and CCY, and no intervention groups of symptomatic choledocholithiasis patients, but also the significant relationship between the incidence of RBEs and that of subsequent cholangiocarcinoma.
