Cholecystectomy reduces subsequent cholangiocarcinoma risk in choledocholithiasis patients undergoing endoscopic intervention

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.

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

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%), and7(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.

Gallstone associated celiac trunk thromboembolisms complicated with splenic infarction:A case report

BACKGROUND Gallstone disease(GD)can have prolonged,subacute inflammatory period before biliary events.The intricate relationship between GD and inflammatory processes can possible lead to prothrombotic tendency that can result in confusing clinical course before diagnosis.CASE SUMMARY A 51-year-old man,presented with a 1-year history of self-relief occasional postprandial upper abdominal pain,had sudden onset severe left upper quadrant pain and visited our emergency room.Contrast enhanced computed tomography(CECT)showed filling defect in celiac trunk,common hepatic,part of splenic arteries and wedge-shaped hypo-enhancing region of spleen,consistent with splenic infarction secondary to splenic arterial occlusion.No convincing predisposing factors were found during first hospitalization.Abdominal pain mildly subsided after low molecular weight heparin and bridge to oral anticoagulant use.However,in the following six months,the patient was admitted twice due to acute cholangitis and finally cholecystitis.Second CECT revealed biliary impacted stone was adjacent to poor dissoluble thrombus.The abdominal pain did not achieve a clinical full remission until endoscopic retrograde cholangiopancreato-graphy stone removal and series laparoscopic cholecystectomy was performed.CONCLUSION This is the first case to present serious thrombotic complication due to inflammation status in chronic GD.It could be a rare,confusing and difficult recognizing cause of a celiac trunk thromboembolic event.