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Dig Dis Sci 2021 Jun 14. Epub 2021 Jun 14.

Department of Gastroenterology, Aichi Medical University, 1-1 Yazakokarimata, Nagakute, Aichi, 480-1195, Japan.

Background: Gemcitabine plus nab-paclitaxel (GnP) is the first-line chemotherapeutic regimen for metastatic pancreatic cancer (MPC); however, there are concerns regarding its safety in patients undergoing biliary stent placement. This study aimed to examine the tolerability and efficacy of GnP in MPC patients who underwent biliary stent placement.

Methods: A total of 105 MPC patients who had received GnP treatment between 2015 and 2020 were included and investigated. Read More

World J Gastrointest Surg 2021 May;13(5):493-506

Gastrointestinal Endoscopy Unit, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo 05403-010, Brazil.

Background: Endoscopic drainage remains the treatment of choice for unresectable or inoperable malignant distal biliary obstruction (MDBO).

Aim: To compare the safety and efficacy of plastic stent (PS) self-expanding metal stent (SEMS) placement for treatment of MDBO.

Methods: This meta-analysis was developed according to Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. Read More

J Hepatobiliary Pancreat Sci 2021 Jun 12. Epub 2021 Jun 12.

Division of Gastroenterology, Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea.

Background/purpose: This study aimed to evaluate the feasibility of endoscopic ultrasound (EUS)-guided antegrade covered stent placement with long duodenal extension (EASL) for malignant distal biliary obstruction (MDBO) with duodenal obstruction (DO) or surgically altered anatomy (SAA) after failed endoscopic retrograde cholangiopancreatography (ERCP).

Methods: Outcomes were technical and clinical success, reintervention rate, adverse events, stent patency, and overall survival. Inverse probability of treatment weighting (IPTW) and competing-risk analysis were performed to compare with conventional EUS-BD. Read More

BMC Vet Res 2021 Jun 10;17(1):215. Epub 2021 Jun 10.

University College Dublin, Belfield, Dublin 4, D04W6F6, Ireland.

Background: The popularity of new world camelids, particularly alpacas, is growing rapidly in Ireland, presenting a clinical challenge to veterinary practitioners who may not have worked with these species previously. To the authors' knowledge, the clinical course of a case of acute fasciolosis in an alpaca has not previously been reported, and fasciolosis has not been reported at all in alpacas in Ireland, making this case report a valuable addition to the current literature.

Case Presentation: A three-year-old male castrated huacaya alpaca was admitted to UCD Veterinary Hospital with a two-day history of colic and tenesmus. Read More

J Hepatobiliary Pancreat Sci 2021 Jun 10. Epub 2021 Jun 10.

TSOZ Pancreatobiliary Study Group, Osaka, Japan.

Background And Aim: Bilateral stent deployment for malignant biliary obstruction (MHBO) can be achieved using side-by-side (SBS) or stent-in-stent (SIS) procedures. Compared with SBS techniques, the procedural steps of SIS are technically complex due to the necessity of introducing the delivery system into a contralateral biliary tract through the mesh of the SEMS. To overcome this issue, a novel uncovered SEMS, the HILZO Moving Cell Stent (MCS) has been released. Read More

J Hepatobiliary Pancreat Sci 2021 Jun 10. Epub 2021 Jun 10.

Mashiko Memorial Hospital, Aichi Prefecture, 35-28 Takebashi-cho, Nakamura-ku, Nagoya, Japan, 4538566.

Background/purpose: The biliary atresia (BA) inflammatory process leads to various obstructive patterns of extrahepatic biliary trees. The significance of the various BA obstructive patterns is unclear. This study aimed to determine the relationship between the anatomical patterns of the biliary tract and short- and long-term prognoses in BA. Read More

Nihon Shokakibyo Gakkai Zasshi 2021 ;118(6):571-577

Department of Pathology, National Hospital Organization Kyushu Cancer Center.

A 76-year-old woman with a history of radiation therapy for vaginal cancer was referred to our hospital because of fever and hepatobiliary dysfunction. Computed tomography showed stenosis of the lower bile duct and edema-like changes in the duodenum from the descending to transverse parts. Endoscopic biliary stenting was performed according to the rendezvous method. Read More

Endoscopy 2021 Jun 9. Epub 2021 Jun 9.

Department of Gastroenterology and Hepatology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands.

Background:  In 2018, the European Society of Gastrointestinal Endoscopy (ESGE) and United European Gastroenterology (UEG) published quality performance measures for endoscopic retrograde cholangiopancreatography (ERCP). Since January 2016, all endoscopists in the Netherlands have been required to register all ERCP procedures in a nationwide quality registry. This study aimed to evaluate the procedural success rates of ERCP after the implementation of mandatory national registration and to compare these with the ESGE quality performance measures. Read More

Transplant Rev (Orlando) 2021 May 29;35(4):100630. Epub 2021 May 29.

Division of Pediatric Gastroenterology and Hepatology, Department of Pediatrics, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands. Electronic address:

Introduction: Portal vein obstruction (PVO) is a significant vascular complication after liver transplantation (LT) in pediatric patients. Current treatment strategies include percutaneous transluminal angioplasty (PTA), with or without stent placement, mesorex bypass (MRB), splenorenal shunt, mesocaval shunt, endovascular recanalization (EVR), splenic artery embolization and splenectomy. However, specific characteristics of patients undergoing intervention and selection of individual treatment and its efficacy have remained unclear. Read More

Dig Endosc 2021 Jun 9. Epub 2021 Jun 9.

Department of Gastroenterology, Aichi Medical University, 1-1 Yazakokarimata, Nagakute, Aichi, 480-1195, Japan.

Endoscopic biliary radiofrequency ablation (RFA) was recently developed as a novel adjunctive procedure and a promising therapeutic option in patients with malignant biliary obstruction (MBO). RFA can achieve local tumor control, resulting in improved biliary stent patency and a potential survival benefit. However, the efficacy of biliary RFA remains controversial, and previous studies have shown conflicting results. Read More

Endoscopy 2021 Jun 8. Epub 2021 Jun 8.

Department of Gastroenterology, Aichi Medical University, Aichi, Japan.

Anticancer Res 2021 Jun;41(6):2979-2984

Department of Oncology, Oulu University Hospital, Oulu, Finland.

Background: The survival benefit of chemotherapy compared to best supportive care (BSC) after percutaneous transhepatic biliary drainage (PTBD) was evaluated in patients with pancreatic or biliary tract cancer.

Patients And Methods: A retrospective registry study was conducted at a tertiary-level university hospital. The endpoint was survival measured from the PTBD and the initiation of chemotherapy. Read More

Clin Endosc 2021 May 28;54(3):301-308. Epub 2021 May 28.

Division of Gastroenterology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.

Endoscopic retrograde cholangiopancreatography (ERCP) is the primary treatment modality for bile duct obstruction. When ERCP is unsuccessful, percutaneous transhepatic biliary drainage can be an alternative method. Endoscopic ultrasound-guided biliary drainage (EUS-BD) has emerged as a treatment option for biliary obstruction, especially after ERCP failure. Read More

Endosc Int Open 2021 Jun 27;9(6):E907-E908. Epub 2021 May 27.

Department of Gastroenterology, Aichi Medical University, Aichi, Japan.

Endosc Int Open 2021 Jun 27;9(6):E888-E894. Epub 2021 May 27.

Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Gastroenterology, Manhasset, New York, United States.

 There are conflicting data regarding the risk of post-ERCP pancreatitis (PEP) with self-expandable metallic stents (SEMS) compared to polyethylene stents (PS) in malignant biliary obstructions and limited data related to benign obstructions.  A retrospective cohort study was performed of 1136 patients who underwent ERCP for biliary obstruction and received SEMS or PS at a tertiary-care medical center between January 2011 and October 2016. We evaluated the association between stent type (SEMS vs PS) and PEP in malignant and benign biliary obstructions. Read More

Pediatr Surg Int 2021 Jun 2. Epub 2021 Jun 2.

Organ Transplantation Center, The National Center for Child Health and Development, 2-10-1 Okura, Setagaya-ku, Tokyo, 157-8535, Japan.

Purpose: The differential diagnosis between Alagille syndrome (AGS) with extrahepatic bile duct obstruction (EHBDO) and biliary atresia (BA) is difficult. We report a case series of AGS with EHBDO with detailed validation of the morphological and histopathological features for the differential diagnosis of BA.

Methods: Six liver transplantations (LTs) were performed for AGS with EHBDO. Read More

Surg Endosc 2021 Jun 2. Epub 2021 Jun 2.

Department of Gastroenterology and Hepatology, Kyoto University Graduate School of Medicine, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan.

Background And Aims: Endoscopic biliary drainage (EBD) is essential for the management of malignant hilar biliary obstruction (MHBO). We prospectively evaluated the efficacy and safety of "inside-stent" therapy, where a plastic stent is placed above the sphincter of Oddi without endoscopic sphincterotomy, in patients with inoperable MHBO.

Methods: This study was a multicenter, single-blinded, randomized controlled trial at three centers. Read More

Semin Oncol 2021 Apr 21. Epub 2021 Apr 21.

Department of Visceral, Vascular and Endocrine Surgery, Martin-Luther-University, Halle-Wittenberg, Halle, Germany. Electronic address:

Pancreatic cancer is one of the most lethal gastrointestinal tumor entities. Surgery is the only chance for cure; however, only a minority of patients can be offered this option. Due to the anatomic location of the gland, tumor-related problems and complications affecting the surrounding structures are common, leading to biliary and gastric outlet obstruction as well as portal vein thrombosis. Read More

Clin Endosc 2021 May 31. Epub 2021 May 31.

Department of Surgical and Perioperative Sciences, Umeå University, Umeå University Hospital, Umeå, Sweden.

Background/aims: Many unanswered questions remain about the treatment of malignant hilar obstruction. We investigated endoscopic stenting for malignant biliary strictures, as reported in a nationwide registry.

Methods: All endoscopic retrograde cholangiopancreatography (ERCP) procedures entered in the Swedish Registry of Gallstone Surgery and ERCP from January 2010 to December 2017 in which stenting was performed for malignant biliary stricture management were included in this study. Read More

J Hepatobiliary Pancreat Sci 2021 May 31. Epub 2021 May 31.

Department of Gastroenterology and Hepatology, Saitama Medical Center, Saitama Medical University, Kawagoe, Japan.

A 66-year-old-male who had undergone endoscopic ultrasound-guided hepaticogastrostomy (EUS-HGS) using an 8 x 100-mm partially covered metal stent (MS) (Modified Giobor stent; Taewoong Medical, Seoul) for obstructive jaundice due to unresectable gallbladder cancer after failed endoscopic retrograde cholangiopancreatography (ERCP) owing to duodenal invasion was admitted because of the second recurrent biliary obstruction (RBO). The first RBO developed due to hyperplasia at an uncovered portion and was treated with adding an uncovered MS three months prior. Read More

GE Port J Gastroenterol 2021 Apr 25;28(3):179-184. Epub 2020 Sep 25.

Department of Gastroenterology and Digestive Endoscopy, Champalimaud Foundation, Lisbon, Portugal.

Endoscopic ultrasound-guided biliary drainage (EUS-BD) is an alternative to percutaneous and surgical drainage in bile duct obstruction when endoscopic retrograde cholangiopancreatography fails. EUS-BD can be achieved with several techniques, including EUS-guided hepaticogastrostomy (HGS), anterograde transpapillary stent placement, choledochoduodenostomy (CDS), and rendez-vous technique. Lately, with increased experience and development of directed equipment, elevated technical and clinical success as well of lower adverse event rates have been reported. Read More

Gut Liver 2021 Jun 2. Epub 2021 Jun 2.

Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.

Background/aims: For the management of hilar malignant biliary obstruction (HMBO), endoscopic biliary drainage (EBD) is preferred over percutaneous transhepatic biliary drainage (PTBD) because of its convenience. However, there is no established guideline for malignant hilar obstruction that requires multiple stenting. In this study, we compared the efficacy of bilateral metal stents (BMS) versus multiple plastic stents (MPS). Read More

Pancreatology 2021 May 25. Epub 2021 May 25.

West Midlands Research Collaborative, Open Plan East, Second Floor, Institute for Translational Medicine, University of Birmingham, Edgbaston, Birmingham, B15 2TH, UK.

Objective: UK national guidelines recommend pancreatic enzyme replacement therapy (PERT) in pancreatic cancer. Over 80% of pancreatic cancers are unresectable and managed in non-surgical units. The aim was to assess variation in PERT prescribing, determine factors associated with its use and identify potential actions to improve prescription rates. Read More

Surg Oncol Clin N Am 2021 Jul;30(3):491-503

Department of Surgery, Division of Trauma Surgery, University of New Mexico; Division of Palliative Medicine, University of New Mexico, Albuquerque, NM, USA. Electronic address:

There is no reason to be pollyannaish when approaching patients with malignant biliary obstruction (MBO). Although technology has allowed refining diagnosis and resectability of cancers causing biliary obstruction, outcomes have not improved significantly. The previous preponderant place of surgical procedures now is replaced by endoluminal and percutaneous techniques for the management of symptoms of MBO. Read More

J Pediatr Surg 2021 Apr 25. Epub 2021 Apr 25.

Division of Pediatric Surgery, Michael E. DeBakey Department of Surgery, Texas Children's Surgical Oncology Program, Texas Children's Liver Tumor Program, Dan L. Duncan Cancer Center, Baylor College of Medicine, Houston, TX USA. Electronic address:

Purpose: Hepatoblastoma (HB) and hepatocellular carcinoma (HCC) are the most common primary malignant tumors of childhood. Intraoperative indocyanine green (ICG) administration with near-infrared imaging (NIR) has emerged as a surgical technology that can be used to assist with localization of pulmonary metastases secondary to HB; however, there has been limited application as an adjunct for resection of the primary liver tumor and assessment of extrahepatic disease.

Methods: We present 14 patients treated for HB, HCC, and malignant rhabdoid tumor at our institution with the use of intraoperative NIR-ICG guidance. Read More

J Med Case Rep 2021 May 28;15(1):311. Epub 2021 May 28.

Inflammatory Lung Disease Research Center, Razi Hospital, Guilan University of Medical Sciences, Rasht, Iran.

Background: Hydatid cysts are fluid-filled sacs containing immature forms of parastic tapeworms of the genus Echinococcus. The most prevalent and serious complication of hydatid disease is intrabiliary rupture, also known as cystobiliary fistulae. In this study, a sporadic case of biliary obstruction, cholangitis, and septicemia is described secondary to hydatid cyst rupture into the common bile duct and intraperitoneal cavity. Read More

Am Surg 2021 May 28:31348211023390. Epub 2021 May 28.

Department of General Surgery, 12279Wake Forest School of Medicine, Winston Salem, NC, USA.

Background: Biliary dyskinesia (BD) is a poorly understood functional gallbladder disorder. Diagnosis is made with abdominal pain and an intact gallbladder without signs of anatomical obstruction on imaging or pathology. Our aim was to assess whether laparoscopic cholecystectomy (LC) resolves hyperkinetic BD symptoms. Read More

J Clin Gastroenterol 2021 May 28. Epub 2021 May 28.

Department of Gastroenterology and Hepatology, Mount Sinai South Nassau, Oceanside, NY.

The field of therapeutic endoscopy has seen many recent advancements. One such emerging field is the use of lumen-apposing metal stents (LAMS). Although a few LAMS have been developed, the most commonly reviewed and the only Food and Drug Administration (FDA)-approved LAMS is the Axios stent by Boston Scientific. Read More

Curr Med Sci 2021 May 28. Epub 2021 May 28.

Department of Ophthalmology, Jiangxi Provincial Children's Hospital, Nanchang, 330006, China.

The exact mechanism by which knockout of Toll-like receptor 4 (TLR4) attenuates the liver injury remains unclear. The present study aimed to examine the role of TLR4 in the pathogenesis of bile duct ligation (BDL)-induced liver cholestatic injury and the underlying mechanism. Wild type (WT) mice and TLR4 knockout (TLR4-KO) mice were used for the establishment of the BDL model. Read More

J Minim Access Surg 2021 May 18. Epub 2021 May 18.

Department of Surgery, SSR Medical College, Belle Rive, Mauritius.

Post-endoscopic retrograde cholangiopancreatography stenting is a well-established treatment for benign as well as malignant biliary obstruction. The most frequently encountered complication is stent clogging. Stent migration (proximal or distal), on the other hand, is not very common. Read More