%0 Journal Article
%T Exploring the association between acute pancreatitis and biliary tract cancer: A large-scale population-based matched cohort study.
%A Selin D
%A Maret-Ouda J
%A Oskarsson V
%A Lindblad M
%A Arnelo U
%A Holmberg M
%A Yang B
%A Sema K
%A Nilsson M
%A Sadr-Azodi O
%J United European Gastroenterol J
%V 12
%N 6
%D 2024 Jul 6
%M 38581617
%F 6.866
%R 10.1002/ueg2.12567
%X <B>BACKGROUND: </B>Biliary tract cancer (BTC) often goes undetected until its advanced stages, resulting in a poor prognosis. Given the anatomical closeness of the gallbladder and bile ducts to the pancreas, the inflammatory processes triggered by acute pancreatitis might increase the risk of BTC.<BR><B>OBJECTIVE: </B>To assess the association between acute pancreatitis and the risk of BTC.<BR><B>METHODS: </B>Using the Swedish Pancreatitis Cohort (SwePan), we compared the BTC risk in patients with a first-time episode of acute pancreatitis during 1990-2018 to a 1:10 matched pancreatitis-free control group. Multivariable Cox regression models, stratified by follow-up duration, were used to calculate hazard ratios (HRs), adjusting for socioeconomic factors, alcohol use, and comorbidities.<BR><B>RESULTS: </B>BTC developed in 0.94% of 85,027 acute pancreatitis patients and in 0.23% of 814,993 controls. The BTC risk notably increased within 3 months of hospital discharge (HR 82.63; 95% CI: 63.07-108.26) and remained elevated beyond 10 years of follow-up (HR 1.82; 95% CI: 1.35-2.47). However, the long-term risk of BTC subtypes did not increase with anatomical proximity to the pancreas, with a null association for gallbladder and extrahepatic tumors. Importantly, patients with acute pancreatitis had a higher occurrence of early-stage BTC within 2 years of hospital discharge than controls (13.0 vs. 3.6%; p-value <0.01).<BR><B>CONCLUSIONS: </B>Our nationwide study found an elevated BTC risk in acute pancreatitis patients; however, the risk estimates for BTC subtypes were inconsistent, thereby questioning the causality of the association. Importantly, the amplified detection of early-stage BTC within 2 years after a diagnosis of acute pancreatitis underscores the necessity for proactive BTC surveillance in these patients.