Association between endoscopic sphincterotomy and the development of hepatopancreatobiliary cancer

Endoscopic retrograde cholangiopancreatography (ERCP) with endoscopic sphincterotomy (ES) has been hypothesized to increase the risk of hepatopancreatobiliary (HPB) cancer, but prior studies have shown conflicting results. This study aimed to determine whether ERCP with ES is associated with the longitudinal development of HPB cancer.

This matched cohort study conducted from 2010 to 2022 used linked medical record data from clinics, hospitals, and other facilities in Southeast Minnesota and Southwest Wisconsin. A total of 188,243 patients were included: 4003 with cholelithiasis or choledocholithiasis who underwent ERCP with ES (Group A), 18,816 underwent cholecystectomy only (Group B), 20,593 received no procedures (Group C), as well as 144,831 healthy controls without cholelithiasis or choledocholithiasis who did not undergo ERCP or cholecystectomy (Group D). Incidence of and time to development of HPB cancer were compared in groups A, B, and C to healthy controls in group D.

The incidence of HPB cancer was 1.2% in Group A, 0.7% in Group B, 0.9% in Group C, and 0.6% in controls. The hazard ratio (HR) for developing HPB cancer compared to controls was highest in the ERCP group (HR 1.64, 95% CI: 1.22-2.22, p = 0.001), followed by the non-procedural group (HR 1.32, 95% CI: 1.12-1.56, p < 0.001). The lowest risk was in the cholecystectomy without ERCP group (HR 1.20, 95% CI: 0.99-1.45, p = 0.06).

This epidemiologic cohort study found that patients who underwent ERCP with ES exhibited a higher incidence of developing HPB cancer over time compared to patients who underwent cholecystectomy alone.