Association between cholecystectomy and adenocarcinoma of the esophagus

Background & Aims: Barrett's esophagus, which is linked to adenocarcinoma o f the esophagus, is associated with reflux of bile. Duodenogastric reflux i s increased after cholecystectomy. This study aims to evaluate if cholecyst ectomy is associated with an increased risk of adenocarcinoma of the esopha gus. Methods: A population-based cohort study of cholecystectomized patient s in Sweden between 1965 and 1997 crosslinked with the Swedish Cancer Regis ter. Results: Cholecystectomized patients had an increased risk of adenocar cinoma of the esophagus (standardized incidence ratio [SIR], 1.3; 95% confi dence interval [CI], 1.0-1.8). Esophageal squamous-cell carcinoma was not f ound to be associated with cholecystectomy (SIR, 0.9; 95% Cl, 0.7-1.1). Pat ients with gallstone disease on whom surgery was not performed did not have an increased risk of adenocarcinoma or squamous-cell carcinoma of the esop hagus. Conclusions: Cholecystectomy is associated with a moderately increas ed risk of adenocarcinoma of the esophagus, possibly by the toxic effect of refluxed duodenal juice on the esophageal mucosa. Further studies are need ed regarding the link between bile reflux and esophageal carcinogenesis.