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Introduction

There were lots of previous references showed cholecystectomy (CCY) can increase the incidence of hepatobiliary and pancreatic cancers, while CCY can reduce the probability of recurrent biliary events in patients after endoscopic retrograde cholangiopancreatography (ERCP) intervention for choledocholithiasis. Chronic inflammatory environments could promote the risk of malignancy, but the current evidence showed in a different way. We need to know the true risk of hepatobiliary cancers in patients, who underwent CCY after choledocholithiasis managed with ERCP.

Aims & Methods

We selected all the patients who underwent first time endoscopic sphincterotomy and endoscopic papillary balloon dilatation in their life time for choledocholithiasis or cholangitis management from 2011 to 2017 in Taiwan. After exclusion the patients had missing data, age under 18, CCY before admission, relevant cancer diagnosed before index date, we collected 13413 patients who accepted CCY after ERCP intervention. We used propensity score matching to get 13330 patients in both CCY and non-CCY group after ERCP intervention. Each specific cancer incidence and mortality were compared between CCY and non-CCY group.

Results

In the CCY group, 60 patients had cholangiocarcinoma and 15 patients had Ampulla Vater cancer (AVC). In the non-CCY group, 168 cases had cholangiocarcinoma and 49 patients had AVC. The incidence rates of cholangiocarcinoma and AVC were 1.19, and 0.3 per 1,000 person-years in the CCY group, all significantly lower than 3.52 (P < 0.0001) and 1.02 (P < 0.0001) per 1,000 person-years, respectively, in the non-CCY group.

Conclusion

CCY is a definite treatment after ERCP intervention for choledocholithiasis or cholangitis, not only reduce the future recurrent biliary events, but also decreased the incidence risks of hepatobiliary cancers.

References

1. Nogueira L, Freedman ND, Engels EA, et al. Gallstones, cholecystectomy, and risk of digestive system cancers. Am J Epidemiol 2014;179:731-9.
2. Liu T, Siyin ST, Yao N, et al. Risk of primary liver cancer associated with gallstones and cholecystectomy: A competing risks analysis. Medicine (Baltimore) 2020;99:e22428.
3. Urbach DR, Swanstrom LL, Khajanchee YS, et al. Incidence of cancer of the pancreas, extrahepatic bile duct and ampulla of Vater in the United States, before and after the introduction of laparoscopic cholecystectomy. Am J Surg 2001;181:526-8.
4. Chow WH, Johansen C, Gridley G, et al. Gallstones, cholecystectomy and risk of cancers of the liver, biliary tract and pancreas. Br J Cancer 1999;79:640-4.

Disclosure

There is no conflict of interest for all the authors

CHOLECYSTECTOMY DECREASE THE INCIDENCE OF HEPATOBILIARY CANCERS AFTER ENDOSCOPIC CHOLEDOCHOLITIASIS MANAGEMENT

Chi Chih Wang 1, Chun-Che Lin 1, Yao-Chun Hsu 2, Ming Chang Tsai 1

1 Chung Shan Medical University Hospital, Taichung, Taiwan, Province of China

2 I-Shou University, Kaohsiung, Taiwan, Kaohsiung, Taiwan, Province of China

Conference

UEG Week Copenhagen 2023

Topics

Hepatobiliary

Submission format

Abstract

Session

PP 07 Liver & biliary (Posters)

Citation

United European Gastroenterology Journal 2023; 11 (Supplement 8)

Published

2023

UEG Podcast Episode

UEG Podcast

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Family history of Colorectal cancer- what's next?

Pradeep Mundre 1, Kevin John Monahan 2

1 Bradford Teaching Hospitals NHS trust, Leeds, United Kingdom

2 West Middlesex Hospital, London, United Kingdom

Topics

Digestive Oncology

Published

2023

UEG Podcast Episode

Journal Podcast

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What are the steps for a successful clinical research career? The voyage to Ithaca

Katarzyna Pawlak 1, Enrique de-Madaria 2

1 Department Gastroenterology, Endoscopy Unit, Hospital of the Ministry of Interior and Administration, Szczecin, Poland

2 Hospital General Universitario de Alicante, Alicante, Spain

Topics

Education & Training

Published

2021

UEG Standards and Guidelines

Clinical Practice Guideline

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Main Recommendations

1 ESGE recommends against diagnostic/therapeutic papillectomy when adenoma is not proven.
Strong recommendation, low quality evidence.

2 ESGE recommends endoscopic ultrasound and abdominal magnetic resonance cholangiopancreatography (MRCP) for staging of ampullary tumors.
Strong recommendation, low quality evidence.

3 ESGE recommends endoscopic papillectomy in patients with ampullary adenoma without intraductal extension, because of good results regarding outcome (technical and clinical success, morbidity, and recurrence).
Strong recommendation, moderate quality evidence.

4 ESGE recommends en bloc resection of ampullary adenomas up to 20–30 mm in diameter to achieve R0 resection, for optimizing the complete resection rate, providing optimal histopathology, and reduction of the recurrence rate after endoscopic papillectomy.
Strong recommendation, low quality evidence.

5 ESGE suggests considering surgical treatment of ampullary adenomas when endoscopic resection is not feasible for technical reasons (e. g. diverticulum, size > 4 cm), and in the case of intraductal involvement (of > 20 mm). Surveillance thereafter is still mandatory.
Weak recommendation, low quality evidence.

6 ESGE recommends direct snare resection without submucosal injection for endoscopic papillectomy.
Strong recommendation, moderate quality evidence.

7 ESGE recommends prophylactic pancreatic duct stenting to reduce the risk of pancreatitis after endoscopic papillectomy.
Strong recommendation, moderate quality evidence.

8 ESGE recommends long-term monitoring of patients after endoscopic papillectomy or surgical ampullectomy, based on duodenoscopy with biopsies of the scar and of any abnormal area, within the first 3 months, at 6 and 12 months, and thereafter yearly for at least 5 years.
Strong recommendation, low quality evidence.

Endoscopic management of ampullary tumors: European Society of Gastrointestinal Endoscopy (ESGE) Guideline

Geoffroy Vanbiervliet

Publisher

European Society of Gastrointestinal Endoscopy

Guideline

Clinical Practice Guideline

Topics

Endoscopy

Citation

Endoscopy 2021; 53(04): 429-448

Published

2021

UEG Standards and Guidelines

Clinical Practice Guideline

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Abstract

Background

Lynch syndrome is the most common genetic predisposition for hereditary cancer but remains underdiagnosed. Large prospective observational studies have recently increased understanding of the effectiveness of colonoscopic surveillance and the heterogeneity of cancer risk between genotypes. The need for gene‐ and gender‐specific guidelines has been acknowledged.

Methods

The European Hereditary Tumour Group (EHTG) and European Society of Coloproctology (ESCP) developed a multidisciplinary working group consisting of surgeons, clinical and molecular geneticists, pathologists, epidemiologists, gastroenterologists, and patient representation to conduct a graded evidence review. The previous Mallorca guideline format was used to revise the clinical guidance. Consensus for the guidance statements was acquired by three Delphi voting rounds.

Results

Recommendations for clinical and molecular identification of Lynch syndrome, surgical and endoscopic management of Lynch syndrome‐associated colorectal cancer, and preventive measures for cancer were produced. The emphasis was on surgical and gastroenterological aspects of the cancer spectrum. Manchester consensus guidelines for gynaecological management were endorsed. Executive and layperson summaries were provided.

Conclusion

The recommendations from the EHTG and ESCP for identification of patients with Lynch syndrome, colorectal surveillance, surgical management of colorectal cancer, lifestyle and chemoprevention in Lynch syndrome that reached a consensus (at least 80 per cent) are presented.

Recommendations for clinical and molecular identification of LS, surgical and endoscopic management of LS‐associated colorectal cancer and preventive measures for cancer were produced. The emphasis was on surgical and gastroenterological aspects of the cancer spectrum.

European guidelines from the EHTG and ESCP for Lynch syndrome: an updated third edition of the Mallorca guidelines based on gene and gender

Toni Seppala

Publisher

European Society for Coloproctology

Guideline

Clinical Practice Guideline

Topics

Digestive Oncology Endoscopy Surgery

Citation

British Journal of Surgery, Volume 108, Issue 5, May 2021, Pages 484–498

Published

2021

UEG Standards and Guidelines

Clinical Practice Guideline

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Main recommendations

ESGE recommends that individuals with hereditary gastrointestinal polyposis syndromes should be surveilled in dedicated units that provide monitoring of compliance and endoscopic performance measures.
Strong recommendation, moderate quality of evidence, level of agreement 90 %.

ESGE recommends performing esophagogastroduodenoscopy, small-bowel examination, and/or colonoscopy earlier than the planned surveillance procedure if a patient is symptomatic.
Strong recommendation, low quality of evidence, level of agreement 100 %.

Keywords: polyposis; screening; surveillance; colonoscopy; esophagogastroscopy; adenomatous polyposis coli; familial adenomatous polyposis; familial cancer; colorectal cancer; juvenile polyposis syndrome; Peutz-Jeghers syndrome