Journal of the National Cancer Institute Advance Access originally published online on May 13, 2008
JNCI Journal of the National Cancer Institute 2008 100(10):745-750; doi:10.1093/jnci/djn102
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© The Author 2008. Published by Oxford University Press.
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Endoscopic Sphincterotomy and Long-Term Risk of Cholangiocarcinoma: A Population-Based Follow-up Study
Affiliations of authors: Departments of Surgical Gastroenterology L (FVM, PFJ, LSJ), Clinical Epidemiology (PJ, HTS), and Medicine V (Hepatology and Gastroenterology) (HTS), Aarhus University Hospital, Aarhus, Denmark; International Epidemiology Institute, Rockville, MD (RET)
Correspondence to: Frank Viborg Mortensen, DMSc, Department of Surgical Gastroenterology L, Aarhus University Hospital, Noerrebrogade 44, 8000 Aarhus C, Denmark (e-mail: fvmor{at}as.aaa.dk).
Sphincterotomy of the ampulla of Vater—a common diagnostic and therapeutic procedure that is sometimes done during endoscopic retrograde cholangiography (ERC)—allows reflux of intestinal content into the biliary tree. The resulting inflammation may contribute to malignant transformation of the biliary epithelium and therefore increase the risk of cholangiocarcinoma. We used data from population-based Danish health-care registries to examine the incidence of cholangiocarcinoma after ERC for 10 690 ERC patients who underwent sphincterotomy between 1977 and 2003 and 10 690 ERC patients who did not undergo sphincterotomy. Patients with sphincterotomy were matched to patients without sphincterotomy by sex and age at, calendar year of, and indication for ERC. The cholangiocarcinoma incidence rate for sphincterotomy patients was 404 per 100 000 person-years during the first year after ERC and decreased progressively at later times after ERC (79, 42, and 27 per 100 000 person-years during years 2, 3–5, and >5, respectively). The corresponding rates for patients without sphincterotomy were 458, 12, 10, and 19 per 100 000 person-years, respectively. The gradual decrease in cholangiocarcinoma rate over time after ERC for sphincterotomy patients indicates that some of these patients had a cholangiocarcinoma that was present at the time of ERC but not diagnosed until 2–5 years later. The similar rates at the latest times after ERC suggest the lack of a causal association between sphincterotomy and cholangiocarcinoma.
| CONTEXT AND CAVEATS Prior knowledge Sphincterotomy of the ampulla of Vater during endoscopic retrograde cholangiography (ERC) is a common diagnostic and therapeutic procedure that allows reflux of intestinal content into the biliary tree, which results in inflammation that may contribute to malignant transformation of the biliary epithelium and, therefore, increase the risk of cholangiocarcinoma. Study design A population-based cohort study using data from Danish health-care registries to examine the incidence of cholangiocarcinoma among ERC patients who did and did not undergo sphincterotomy. Contribution The cholangiocarcinoma incidence rates for sphincterotomy patients were 404 per 100 000 person-years during the first year after ERC and decreased progressively at later times after ERC (79, 42, and 27 per 100 000 person-years during years 2, 3–5, and >5, respectively). The corresponding rates for patients without sphincterotomy were 458, 12, 10, and 19 per 100 000 person-years, respectively. Implications Reflux after sphincterotomy does not appear to have a causal role in the development of cholangiocarcinoma. Limitations The number of cholangiocarcinomas was small. The association between sphincterotomy and risk of cholangiocarcinoma could be confounded by unknown or unmeasured risk factors for cholangiocarcinoma.
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Manuscript received October 18, 2007; revised February 22, 2008; accepted March 11, 2008.
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J Natl Cancer Inst 2008 100: 687.