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Huang D, Lee J, Song N, Cho S, Choe S, Shin A. Gallstones, Cholecystectomy and the Risk of Hepatobiliary and Pancreatic Cancer: A Nationwide Population-based Cohort Study in Korea. J Cancer Prev 2020; 25:164-172. [PMID: 33033710 PMCID: PMC7523037 DOI: 10.15430/jcp.2020.25.3.164] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 09/21/2020] [Accepted: 09/21/2020] [Indexed: 11/03/2022] Open
Abstract
Several epidemiological studies suggest a potential association between gallstones or cholecystectomy and hepatobiliary and pancreatic cancers (HBPCs). The aim of this study was to evaluate the risk of HBPCs in patients with gallstones or patients who underwent cholecystectomy in the Korean population. A retrospective cohort was constructed using the National Health Insurance Service-National Sample Cohort (NHIS-NSC). Gallstones and cholecystectomy were defined by diagnosis and procedure codes and treated as time-varying covariates. Hazard ratios (HRs) in relation to the risk of HBPCs were estimated by Cox proportional hazard models. Among the 704,437 individuals who were included in the final analysis, the gallstone prevalence was 2.4%, and 1.4% of individuals underwent cholecystectomy. Between 2002 and 2015, 487 and 189 individuals developed HBPCs in the gallstone and cholecystectomy groups, respectively. A significant association was observed between gallstones and all HBPCs (HR 2.16; 95% CI 1.92-2.42) and cholecystectomy and all HBPCs (HR 2.03; 95% CI 1.72-2.39). However, when 1-, 3-, and 5-year lag periods were applied, the HBPC and subsites risk approached zero. A significant association was observed between cholecystectomy and intrahepatic bile duct cancer (IBDC) (HR 2.68; 95% CI 1.63-4.40). When 1-, 3- and 5-year lag periods were applied, the IBDC risk after cholecystectomy was 2.86-fold (95% CI 1.68-4.85), 2.92-fold (95% CI 1.51-5.64), and 4.08-fold (95% CI 1.94-8.61) higher, respectively, than that in the comparison group. In conclusion, gallstone diagnosis and cholecystectomy seem to correlate with HBPCs, especially cholecystectomy and IBDC.
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Affiliation(s)
- Dan Huang
- Department of Preventive Medicine, Seoul National University College of Medicine, Seoul, Korea.,Division of Cancer Control and Policy, National Cancer Control Institute, National Cancer Center, Goyang, Korea
| | - Joonki Lee
- Department of Preventive Medicine, Seoul National University College of Medicine, Seoul, Korea.,Division of Cancer Control and Policy, National Cancer Control Institute, National Cancer Center, Goyang, Korea
| | - Nan Song
- Cancer Research Institute, Seoul National University, Seoul, Korea.,Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Sooyoung Cho
- Department of Preventive Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Sunho Choe
- Department of Preventive Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Aesun Shin
- Department of Preventive Medicine, Seoul National University College of Medicine, Seoul, Korea.,Cancer Research Institute, Seoul National University, Seoul, Korea
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Hemorrhage from bile duct varices treated with fully covered expandable metallic stent placement in pancreatic carcinoma. Clin J Gastroenterol 2013; 6:80-3. [PMID: 26181409 DOI: 10.1007/s12328-012-0354-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2012] [Accepted: 12/16/2012] [Indexed: 10/27/2022]
Abstract
A 64-year-old woman with unresectable pancreatic body carcinoma was admitted with epigastralgia with a sudden onset 6 h earlier. She had received chemotherapy for her cancer for 2 months. Physical examination showed mild anemia. Contrast-enhanced computed tomography showed dilated vessels in the bile duct walls connecting with dilated and tortuous vessels around the extrahepatic bile duct and portal vein obstruction due to invasion by a pancreatic body tumor. Endoscopic examination showed transpapillary hemorrhage suggesting bile duct hemorrhage. On endoscopic retrograde cholangiopancreatography, the lower bile duct was filled with a mass and the middle bile duct had filling defects with compression of the wall. To stop the bleeding, we placed a fully covered expandable metallic stent (EMS) at the middle to lower portion of the bile duct, and the hemorrhage stopped. Bile duct hemorrhage is not a common disorder. This report shows bile duct hemorrhage from bile duct varices can occur in patients with pancreatic carcinoma with portal obstruction and that fully covered EMS placement can stop the hemorrhage.
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Ben Chaabane N, Melki W, Safer L, Bdioui F, Halara O, Saffar H. Ictère cholestatique secondaire à un cavernome porte : à propos d'un cas. ACTA ACUST UNITED AC 2006; 131:543-6. [PMID: 16836970 DOI: 10.1016/j.anchir.2006.02.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2005] [Accepted: 02/18/2006] [Indexed: 10/24/2022]
Abstract
Portal biliopathy is due to compression of the common bile duct by varicose veins constituting portal cavernoma. Usually asymptomatic, it can occasionally be responsible for jaundice or cholangitis. We report a case of portal cavernoma secondary to pylephlebitis complicating acute appendicitis, followed eleven years later by occurrence of cholestatic jaundice. Diagnosis of portal biliopathy was done by imaging and confirmed by endoscopic retrograde cholangiography with insertion of a plastic stent into common bile duct. This stent was periodically changed and allowed regression of jaundice with a 3-year follow-up. Through a review of the literature, both clinical and therapeutic characteristics of portal biliopathy were studied.
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Affiliation(s)
- N Ben Chaabane
- Service de gastroentérologie, CHU de Monastir, 5000 Monastir, Tunisie.
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Sezgin O, Oğuz D, Altintaş E, Saritaş U, Sahin B. Endoscopic management of biliary obstruction caused by cavernous transformation of the portal vein. Gastrointest Endosc 2003; 58:602-8. [PMID: 14520303 DOI: 10.1067/s0016-5107(03)01975-8] [Citation(s) in RCA: 56] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Symptomatic biliary obstruction caused by cavernous transformation of the portal vein is an extremely rare disorder for which there is no consensus as to optimal treatment. The results of endoscopic treatments in a small group of patients is reviewed. METHODS A total of 10 patients (5 men, 5 women; mean age 36.1 years, range 17-48 years) with severe biliary strictures were treated between 1995 and 2001. Biliary sphincterotomy was performed in all patients. Four patients also underwent balloon dilation, nasobiliary drainage, and stone or sludge extraction by using a balloon. All patients had stent insertion. OBSERVATIONS The mean duration of therapy was 3.3 years (range 1-7 years). There was no complication directly related to the endoscopic procedures except for hemobilia that occurred in one patient during stent removal. Cholangitis developed in 5 patients during the therapy period and was treated endoscopically. In 4 patients, significant improvement in the biliary stricture was observed and stents were removed in 3. These patients were followed without stent insertion for one year. CONCLUSIONS Endoscopic management of biliary stricture caused by cavernous transformation of the portal vein appears to be effective and safe.
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Affiliation(s)
- Orhan Sezgin
- Gastroenterology Department of Mersin University Medical Faculty, Mersin, Turkey
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Vibert E, Azoulay D, Castaing D, Bismuth H. [Portal cavenorma: diagnosis, aetiologies and consequences]. ANNALES DE CHIRURGIE 2002; 127:745-50. [PMID: 12538094 DOI: 10.1016/s0003-3944(02)00897-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Portal cavernoma is a network of veins whose caliber, initially millimetric or microscopic, is increased and which contain hepatopedal portal blood. It results from occlusion, thrombotic and always chronic, of the extra-hepatic portal system. Diagnosis is mainly done by imaging. Clinical signs of portal cavernoma are usually related to extra-hepatic portal hypertension (hematemesis due to rupture of oeso-gastric varices, splenomegaly, rectal bleeding from ano-rectal varices, growth retardation in children) and sometimes to the cause of portal hypertension (abdominal pain, venous bowel infarction). Occurrence of portal thrombosis is often the conjunction of a local cause and a prothrombotic disorder which must be systematically detected. Biliary consequences of cavernoma are related to compression of common bile duct and are usually asymptomatic. In case of jaundice or cholangitis, portal decompression by portosystemic shunt can be performed to treat both biliary symptoms and portal hypertension.
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Affiliation(s)
- Eric Vibert
- Centre hépato-biliaire, hôpital Paul-Brousse, université Paris-Sud EPRES 1596, 94804 Villejuif, France
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