Association of Endoscopic Sphincterotomy or Papillary Balloon Dilatation and Biliary Cancer

Abstract

Endoscopic sphincterotomy (EST) and endoscopic papillary balloon dilatation (EPBD) have become the main therapeutic procedures in the treatment of biliary and pancreas disease. The risk of cholangiocarcinoma (CCA) is not well investigated among post-EST/EPBD patients with benign diseases, particularly in Asia population.A retrospective nationwide cohort study using data from Taiwan's National Health Insurance Research Database (from January 1, 1998 through December 31, 2010) was conducted. Among patients with history of biliary stone with cholangitis, there were 17,503 patients in the EST/EPBD cohort and 69,998 subjects in the comparison. The incidence rate ratio was calculated using the Poisson regression model. Multivariable Cox proportional hazard models, adjusted for potential confounding factors, were used to assess the risk of developing CCA associated with endoscopic EST/EPBD. The cumulative incidences of CCA in the 2 cohorts were calculated using Kaplan–Meier analyses, and differences between the survival curves of the 2 cohorts were analyzed using a log-rank test.The overall incidence of CCA in the EST/EPBD cohort was higher than in the controls (1.36 vs 7.37 per 1000 person-years, IRR = 5.40, 95% CI = 5.15–5.67), with an adjusted HR of 4.41 (95% CI = 3.86–5.04). There were no CCA occurrences among patients receiving EST over the follow-up period 3 year after EST performed. The cumulative incidence of extrahepatic CCA seemed to be little growing in patients receiving EPBD. The cumulative incidence of intrahepatic CCA was also steady increasing in patients treated with EPBD and was more than patients receiving EST 10 years after EPBD by Kaplan–Meier analysis.In the population-based cohort study, EST is not associated with a long-term risk of intrahepatic and extrahepatic CCA. The risk of CCA for EPBD needs further investigation.

Risk of cholangiocarcinoma in patients undergoing therapeutic endoscopic retrograde cholangiopancreatography or cholecystectomy: A population based study

“…ES had been shown to increase biliary epithelial atypia[ 27 ], and previous data have indicated that therapeutic ERCP can increase the subsequent cholangiocarcinoma rate[ 28 ]. At the same time, many recent larger population-based studies have demonstrated that ES does not increase the incidence of cholangiocarcinoma[ 29 - 31 ]. Even some evidence has suggested that ES does not increase the subsequent cholangiocarcinoma rate over that seen with EPBD[ 29 ].…”

“…At the same time, many recent larger population-based studies have demonstrated that ES does not increase the incidence of cholangiocarcinoma[ 29 - 31 ]. Even some evidence has suggested that ES does not increase the subsequent cholangiocarcinoma rate over that seen with EPBD[ 29 ]. At the same time, cholelithiasis and cholecystectomy had been of concern due to the increase in ICC[ 32 ] and ECC[ 33 ], but some studies have shown that cholecystectomy decreases the subsequent cholangiocarcinoma rate in cholelithiasis patients[ 34 ].…”

Long-Term Risks of Benign and Malign Complications after Endoscopic Sphincterotomy in the Management of Benign Biliopancreatic Pathology: A Cohort Study

“…A Danish study found a higher incidence of cholangiocarcinoma in the first year after sphincterotomy, but the number of tumors equalized with the control group during long-term follow-up. 19 Other studies from Finland and Sweden, with a large number of patients who underwent sphincterotomy, did not find significant differences in the long-term incidence of tumors compared to the control group. 22 …”

“…Previous studies have presented conflicting findings regarding the association between sphincterotomy and the development of biliary and pancreatic neoplasms. 10 , 19 - 21 …”

Risk of pyogenic liver abscess and endoscopic sphincterotomy: a population-based cohort study

“…18 The details of the NHI programme and the NHIRD have been well documented in previous studies. 16 19 Diseases were coded in the NHIRD according to the 2001 International Classification of Diseases, Ninth revision, Clinical Modification (ICD-9-CM).…”