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J Surg Case Rep 2019 Mar 6;2019(3):rjz081. Epub 2019 Apr 6.

Acute Care Surgery Service, Good Samaritan Regional Medical Center, Corvallis, OR 97330, USA.

Biliary obstruction is a common problem associated with gallbladder pathology. However, hemorrhagic cholecystitis with hemobilia as the cause is quite rare. We present a case of hemorrhagic cholecystitis in the setting of systemic anticoagulation causing common bile duct obstruction which required endoscopic retrograde cholangiopancreatography (ERCP) for ductal clearance followed by laparoscopic cholecystectomy. Read More

Toxicol Lett 2019 Apr 15. Epub 2019 Apr 15.

Center of Toxicology Science & Research, Medical School, University of Crete, Heraklion, Crete, Greece; Department of Analytical and Forensic Medical Toxicology, Sechenov University, Moscow 119991, Russian Federation. Electronic address:

The aim of the current study was to evaluate the effects of a mixture of thirteen common chemicals on rats, after a one-year exposure to doses around the acceptable daily intake (ADIs), using blood and urinary tests. The influence of low doses of the mixture on weight gain, water consumption, feed consumption and feed efficiency, biochemistry parameters, haematological parameters, blood lymphocytes subsets, serum inflammation profile and urine parameters was evaluated. Our mixture caused a moderate monotonic increase of the males' appetite and a non-monotonic increase of anabolism and a monotonic increase of appetite for the females. Read More

Radiology 2019 May;291(2):542-545

From the Department of Diagnostic Radiology, Singapore General Hospital, Outram Road, Singapore 169608.

History A 70-year-old man presented to the emergency department with fever, chills, rigors, and upper abdominal discomfort. Physical examination revealed jaundice and mild right upper quadrant tenderness. Laboratory tests revealed an increased C-reactive protein level of 133 mg/L (normal range, 0. Read More

Minerva Med 2019 Apr 16. Epub 2019 Apr 16.

Department of Hepatopancreatobiliary Surgery, Tianjin Medical University Second Hospital, Tianjin Medical University, Tianjin, China -

Introduction: EUS-Guided biliary drainage was used as an alternative method for patients who failed ERCP. In recent years, an increasing number of patients was treated with EUS-BD,but lack of data was available to value the efficacy and safety between EUS and ERCP. Therefore, a review was needed to evaluate the similarities and differences between the two methods and explored whether EUS-Guided biliary drainage could be considered as first-line treatment. Read More

Dig Endosc 2019 Apr;31 Suppl 1:50-54

Gastrointestinal Endoscopy Excellence Center and Division of Gastroenterology, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand.

Adequate biliary drainage (BD), defined as more than 50% of liver volume drained, is an ideal BD method in patients with advanced and unresectable malignant hilar biliary obstruction (MHBO). Endoscopic retrograde cholangiopancreatography (ERCP) with multi-segmental BD is technically challenging. ERCP with percutaneous biliary drainage (PTBD) or PTBD alone has cumbersome maintenance of PTBD line and external bag. Read More

Endosc Int Open 2019 Apr 12;7(4):E600-E607. Epub 2019 Apr 12.

Division of Gastroenterology and Hepatology, Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina, United States.

 Endoscopic ultrasound-guided hepaticoenterostomy (EUS-HE) is an effective method of endoscopic biliary drainage in cases where endoscopic retrograde cholangiopancreatography has failed or is deemed impossible. Indications for EUS-HE have expanded, resulting in increased interest by endoscopists to learn the procedure; however, few data exist on breadth of application or experience needed to develop proficiency. We describe utilization of EUS-HE for biliary decompression at a large tertiary referral center along with procedural learning curve. Read More

J Laparoendosc Adv Surg Tech A 2019 Apr 13. Epub 2019 Apr 13.

1 Department of Pediatric Surgery, Medical Faculty Mannheim, Heidelberg University, University Medical Center, Mannheim, Germany.

Purpose: There is a lack of experience with stenting for benign pancreaticobiliary disorders in children.

Materials And Methods: Fifteen children (9 male and 6 female) with a median age of 7.1 years (range 0. Read More

Gastrointest Endosc 2019 Apr 9. Epub 2019 Apr 9.

Division of Gastroenterology and Hepatology, University of Colorado Anschutz Medical Center, Aurora, Colorado, USA. Electronic address:

Each year choledocholithiasis results in biliary obstruction, cholangitis, and pancreatitis in a significant number of patients. The primary treatment, ERCP, is minimally invasive but associated with adverse events in 6% to 15%. This American Society for Gastrointestinal Endoscopy (ASGE) Standard of Practice (SOP) Guideline provides evidence-based recommendations for the endoscopic evaluation and treatment of choledocholithiasis. Read More

J Surg Oncol 2019 Apr 12. Epub 2019 Apr 12.

Department of Radiology, Section of Interventional Radiology, Northwestern University, Chicago, Illinois.

Percutaneous biliary interventions have established their role in the management of benign and malignant biliary disease. There are limited data comparing procedures performed by gastroenterologists and interventional radiologists in managing malignant biliary obstruction. Endoscopic procedures performed by gastroenterologists are not completely benign with reported complications ranging from 2% to 15%. Read More

Transl Gastroenterol Hepatol 2019 13;4:10. Epub 2019 Feb 13.

Department of Gastroenterology, Rutgers Robert Wood Johnson University Hospital, New Brunswick, NJ, USA.

Endoscopic ultrasound-guided biliary drainage (EUS-BD) has become widely accepted over the past several years for complicated biliary drainage. When conventional endoscopic retrograde cholangiopancreatography (ERCP) is not successful or feasible due to a variety of constraints, an ultrasound-guided technique through intrahepatic and extrahepatic approaches allows adequate management of hepatobiliary obstruction. Other management alternatives include percutaneous transhepatic biliary drainages (PTBD) and complicated surgical approaches, both of which can be associated with increased morbidity and mortality. Read More

J Biol Regul Homeost Agents 2019 Mar-Apr;33(2):571-579

Department of Surgery 2, TongLu First People's Hospital, Tonglu, Hangzhou, Zhejiang Province, China.

The aim of this study was to investigate the mechanism of hepatocyte apoptosis and regeneration after partial hepatectomy in obstructive jaundice (OJ) rats under different drainage methods of bile acid intervention. Forty male Sprague Dawley rats were randomly divided into five groups. An OJ rat model was established by the following protocols. Read More

Gut Liver 2019 Apr 17. Epub 2019 Apr 17.

Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.

Background/aims: : Metallic stents designed to relieve malignant biliary obstruction are susceptible to occlusive tumor ingrowth or overgrowth. In a previous report, we described metallic stents covered with paclitaxel-incorporated membrane (MSCPM-I, II) to prevent occlusion from tumor ingrowth via antitumor effect. This new generation paclitaxeleluting biliary stent is further endowed with sodium caprate (MSCPM-III) for enhanced drug delivery. Read More

Abdom Radiol (NY) 2019 Apr 9. Epub 2019 Apr 9.

Department of Medical Imaging, Xuzhou Central Hospital, 199 South Jiefang Road, Xuzhou, China.

Purpose: To compare the clinical outcomes between unilateral and bilateral metal stenting for patients with malignant hilar biliary obstruction (MHO).

Methods: This is a single-center, open-label, prospective, randomized study. Between January 2016 and March 2018, patients with MHO who were treated by percutaneous unilateral or bilateral metal stenting were enrolled. Read More

Clin J Gastroenterol 2019 Apr 8. Epub 2019 Apr 8.

Department of Gastroenterology, Tottori Prefectural Central Hospital, Tottori, Japan.

Intraductal papillary mucinous neoplasms (IPMNs) occasionally form a fistula to adjacent organs, resulting in obstructive jaundice and cholangitis due to mucus obstruction. Although some procedures such as endoscopic nasobiliary drainage are attempted, they often do not work adequately because of high mucus viscosity. Herein, we report the case of an 87-year-old man with obstructive cholangitis treated by endoscopic septotomy and mucus suction with direct peroral cholangioscopy using conventional endoscopy. Read More

J Surg Oncol 2019 Apr 5. Epub 2019 Apr 5.

Department of Surgery, Surgical Outcomes and Quality Improvement Center, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.

Background: Pancreatic fistula remains common, with limited ability to risk stratify patients preoperatively. The objective of this study was to identify risk factors for clinically-relevant postoperative pancreatic fistula (CR-POPF) that are routinely available in the preoperative setting.

Methods: Preoperatively available variables for all pancreaticoduodenectomies from 2014-2017 were examined using a national clinical registry. Read More

J Hepatobiliary Pancreat Sci 2019 Apr 5. Epub 2019 Apr 5.

First department of internal medicine, Gifu University Hospital, Gifu, Japan.

Background: Bilateral self-expandable metallic stent (SEMS) placement is effective for long-term management of unresectable malignant hilar biliary obstruction (UMHBO). However, endoscopic reintervention (ERI) for bilateral SEMSs is not well-studied. This study aimed to evaluate ERI efficacy after stent-in-stent placement METHODS: Data of 31 patients who underwent ERI from May 2000 to July 2018 were analyzed. Read More

Hum Pathol 2019 Apr 1. Epub 2019 Apr 1.

Department of Pathology and Immunology, School of Medicine, Washington University in St. Louis, 425 S Euclid Ave, Campus Box 8118, St. Louis, MO, USA 63110.. Electronic address:

Follicular cholecystitis (FC) is a relatively rare entity with uncertain causal associations. In this study, we aimed to explore different clinicopathologic associations of FC, and to better characterize the entity. A retrospective review of archival H&E slides and pertinent clinical information was undertaken for all cholecystectomy cases with a rendered diagnosis of "follicular cholecystitis", from 1991 to 2017. Read More

Gastroenterol Res Pract 2019 28;2019:2789764. Epub 2019 Feb 28.

National Institute of Medical Science and Nutrition Salvador Zubiran, Department of Gastroenterology, Mexico City, Mexico.

Nosocomial extrapancreatic infections in patients with acute pancreatitis (AP) are associated with a higher mortality even after adjusting the risk for the severity of the pancreatitis. The aim of this study was to describe the clinical features of hospitalized patients with AP who died during their hospitalization and to evaluate risk factors associated with mortality. We performed a descriptive study of the clinical features of adult patients who died from AP during their hospitalization and a case control study with a paired group of patients that survived AP during a 10-year period. Read More

Dig Endosc 2019 Apr 3. Epub 2019 Apr 3.

Saitama Medical University, Community Health Science Center.

Objectives: To analyze factors of procedural failure and to discuss responses to procedural failure, by using the outcomes of endoscopic retrograde cholangiopancreatography (ERCP), performed using a short-type single-balloon enteroscope (short SBE) in patients with surgically altered gastrointestinal anatomy.

Methods: The study sample included patients who underwent ERCP-related procedures using a short SBE, between September 2011 and September 2018, at our hospital. Outcomes, including the procedural success rate, were studied retrospectively to analyze the factors of procedural failure. Read More

Int J Colorectal Dis 2019 Apr 2. Epub 2019 Apr 2.

Sorbonne Université, Assistance Publique Hôpitaux de Paris, Department of Digestive and Hepatopancreato-Biliary Surgery, Pitié Salpêtrière University Hospital, 47-83 Bd de l'Hôpital, 75651, Paris Cedex 13, France.

Purpose: Few studies compared management and outcomes of obstructing colonic cancer (OCC), according to the tumor site. Our aim was to compare patient and tumor characteristics, postoperative and pathological results, and oncological outcomes after emergency management of right-sided vs. left-sided OCC. Read More

Khirurgiia (Mosk) 2019 (3):48-59

Pirogov Russian National Research Medical University, Moscow, Russia; Filatov Munitsipal Children's Hospital, Moscow, Russia.

Aim: To compare early and long-term results of different surgical interventions in children with biliary atresia.

Material And Methods: Retrospective analysis included medical records of children with biliary atresia who were treated at the Filatov Munitsipal Children's Hospital and National Medical Research Center for Obstetrics, Gynecology and Perinatology from 2000 to 2018. There were 91 patients. Read More

Zhonghua Wai Ke Za Zhi 2019 Apr;57(4):288-292

Ultrasonography Room, First Affiliated Hospital of Bengbu Medical College, Bengbu 233000, China.

To investigate the effects of preoperative percutaneous transhepatic biliary drainage on surgical treatment of type Ⅲ and Ⅳ hilar cholangiocarcinoma. Clinical data of 72 patients with hilar cholangiocarcinoma of the Bismuth-Corlette type Ⅲ and Ⅳ treated at Department of General Surgery,First Affiliated Hospital of Bengbu Medical College from January 2010 to December 2017 were analyzed retrospectively.Patients were divided into two groups based on whether PTBD was performed:a drained group and an undrained group. Read More

Gastrointest Endosc 2019 Mar 27. Epub 2019 Mar 27.

The ASGE's GIE Editorial Board reviewed original endoscopy-related articles published during 2018 in GIE and 10 other leading medical and gastroenterology journals. Votes from each individual member were tallied to identify a consensus list of 10 topic areas of major advances in gastrointestinal endoscopy. Individual board members summarized important findings published in these 10 areas of adenoma detection, bariatric endoscopy, endoscopic mucosal resection (EMR)/submucosal dissection (ESD)/full thickness resection (EFTR), artificial intelligence, expandable metal stents for palliation of biliary obstruction, pancreatic therapy with lumen apposing metal stents, endoscope reprocessing, Barrett's esophagus, interventional EUS, and gastrointestinal bleeding. Read More

Int J Surg Case Rep 2019 Mar 21;57:84-87. Epub 2019 Mar 21.

Department of Hepato-Pancreato-Biliary and Transplant Surgery, Academia Level 5, 20 College Road, Singapore, 169856, Singapore. Electronic address:

Introduction: Gallstone(s) impacted at the distal small bowel causing intestinal obstruction as a result of cholecystoenteric fistula is a well-known, albeit uncommon surgical condition. The rare Bouveret's Syndrome, which refers to the proximal impaction of gallstone(s) in the duodenum or pylorus resulting in the gastric outlet obstruction (GOO), has also been described in the literature. However, gallbladder mucocele with extrinsic compression of the duodenum and/or pylorus causing GOO is a separate entity that is extremely rare. Read More

Br J Radiol 2019 Apr 9:20180890. Epub 2019 Apr 9.

2 Radiodiagnosis and Imaging, PGIMER , Chandigarh , India.

Objective: To investigate the liver parenchymal changes on MRI in patients with extrahepatic portal venous obstruction (EHPVO).

Methods: This was a retrospective evaluation of the MRI studies in patients with EHPVO between January 2016 and April 2018. The diagnosis of EHPVO in each case had been established on the basis of clinical and Doppler parameters. Read More

Clin Exp Hepatol 2019 Mar 20;5(1):48-54. Epub 2019 Feb 20.

Department of Biochemistry, Osteoarthritis and Musculoskeleton Research Unit, Faculty of Medicine, Chulalongkorn University, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand.

Aim Of The Study: Biliary atresia (BA) is an uncommon disorder of the liver and bile ducts affecting infants and is characterized by progressive fibrosclerosing obstruction of the extrahepatic biliary tree leading to end-stage liver failure. The purpose of this study was to determine serum glypican-3 (GPC3) levels and liver stiffness in children with BA and the correlation of glypican-3 with clinical parameters.

Material And Methods: Seventy-five post-Kasai BA patients and 28 healthy age-matched controls were registered. Read More

Dig Endosc 2019 Mar 25. Epub 2019 Mar 25.

Therapeutic Endoscopic Ultrasound Group, Osaka, Japan.

Objectives: Endoscopic ultrasound-guided biliary drainage (EUS-BD) can be performed via two different approaches: choledochoduodenostomy (CDS) and hepaticogastrostomy (HGS). We compared the efficacy and safety of these approaches in malignant distal biliary obstruction (MDBO) patients using a prospective, randomized clinical trial.

Methods: MDBO patients after failed ERCP were randomly selected for either CDS or HGS. Read More

Am J Transplant 2019 Mar 14. Epub 2019 Mar 14.

Department of Pediatric Gastroenterology and Hepatology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.

Secondary protein-losing enteropathy (PLE) is a rare complication following pediatric liver transplantation (LT), mostly related to venous outflow obstruction of the liver. Here, we discuss a thus far unknown cause of secondary PLE following pediatric LT. A 7-month-old boy underwent LT with biliary anastomosis using a Roux-en-Y jejunal loop. Read More

Clin Endosc 2019 Mar 14. Epub 2019 Mar 14.

Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.

Although endoscopic retrograde cholangiopancreatography (ERCP) is the first-line treatment for benign biliary diseases, this procedure is technically difficult in some conditions such as a surgically altered anatomy and gastric outlet obstruction. After a failed ERCP, a surgical or a percutaneous approach is selected as a rescue procedure; however, various endoscopic ultrasound (EUS)-guided interventions are increasingly utilized in pancreatobiliary diseases, including EUS-guided rendezvous for failed biliary cannulation, EUS-guided antegrade treatment for stone management, and EUS-guided hepaticogastrostomy for anastomotic strictures in patients with a surgically altered anatomy. There are some technical hurdles in EUS-guided interventions for benign biliary diseases owing to the difficulty in puncturing a relatively small bile duct and in subsequent guidewire manipulation, as well as the lack of dedicated devices. Read More

Surg Endosc 2019 Mar 12. Epub 2019 Mar 12.

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

Background: Endoscopic retrograde cholangiopancreatography (ERCP) was introduced more than four decades ago as a diagnostic tool for biliary and pancreatic diseases. Currently, ERCP is mainly used as a therapeutic approach to relieve biliary or pancreatic duct obstruction. Clinical practice has been based on a few large reports and some randomized controlled trials. Read More

Clin Exp Gastroenterol 2019 18;12:83-92. Epub 2019 Feb 18.

Department of Gastroenterology and Hepatology, Fiona Stanley Hospital, Murdoch, Perth, WA 6150, Australia,

Benign biliary strictures (BBSs) may form from chronic inflammatory pancreaticobiliary pathologies, postoperative bile-duct injury, or at biliary anastomoses following liver transplantation. Treatment aims to relieve symptoms of biliary obstruction, maintain long-term drainage, and preserve liver function. Endoscopic therapy, including stricture dilatation and stenting, is effective in most cases and the first-line treatment of BBS. Read More

BMC Pediatr 2019 Mar 11;19(1):78. Epub 2019 Mar 11.

Discipline of Paediatrics, School of Women's and Children's Health, Medicine, University of New South Wales, Sydney, NSW, Australia.

Background: Cholecystoduodenostomy is a surgical procedure that bypasses the extrahepatic biliary tree and connects the gallbladder directly to the duodenum. This case describes the successful use of this procedure in a novel situation.

Case Presentation: A premature (34 weeks gestation) female infant with cystic fibrosis required a laparotomy on day 1 of life due to an intrauterine small bowel perforation. Read More

J Gastrointestin Liver Dis 2019 Mar;28(1):125-128

Digestive Endoscopy Unit, Department of Gastroenterology, Humanitas Research Hospital, Rozzano, Milan, Italy.

We present five cases of pylorus-preserving pancreaticoduodenectomy (PPPD) after endoscopic ultrasonography-guided choledochoduodenostomy (EUS-CD) using a lumen-apposing metal stent (LAMS) as a bridge to surgery in patients with resectable distal malignant biliary obstruction and failed endoscopic retrograde cholangiopancreatography (ERCP). The patients underwent an EUS-CD using EC-LAMS, the bile duct being accessed using the transbulbar approach. The technical success rate of EUS-CD was 100%. Read More

J Med Case Rep 2019 Mar 9;13(1):72. Epub 2019 Mar 9.

Alfred Hospital, 55 Commercial Rd, Melbourne, VIC, 3004, Australia.

Introduction: Gastric adenocarcinoma is a known complication of partial gastrectomy. Jaundice from gastric adenocarcinoma usually occurs in the setting of hepatic nodal or parenchymal metastasis. This case demonstrates an unusual level of biliary obstruction from gastric adenocarcinoma. Read More

Gastrointest Endosc Clin N Am 2019 Apr 2;29(2):351-367. Epub 2019 Feb 2.

Division of Gastroenterology and Hepatology, University of Virginia, PO Box 800708, Charlottesville, VA 22908, USA. Electronic address:

Most patients with perihilar cholangiocarcinoma present with surgically unresectable disease owing to the insidious nature of this malignancy. Relief of malignant perihilar biliary obstruction is a key aspect of cholangiocarcinoma. Although palliative stenting using uncovered metal stents has been advocated in patients with unresectable malignant perihilar biliary strictures, several endoscopic retrograde cholangiopancreatography-guided ablative modalities have emerged. Read More

Gastrointest Endosc Clin N Am 2019 Apr 23;29(2):215-235. Epub 2019 Jan 23.

Interventional Endoscopy, Washington University School of Medicine in St. Louis, 660 South Euclid Avenue, Campus Box 8124, St Louis, MO 63110, USA. Electronic address:

Benign and malignant biliary strictures are common indications for endoscopic retrograde cholangiopancreatography. Diagnosis involves high-quality cross-sectional imaging and cholangiography with various endoscopic sampling techniques. Treatment options include placement of plastic biliary stents and self-expanding metal stents, which differ in patency duration and cost effectiveness. Read More

Surg Clin North Am 2019 Apr;99(2):387-401

General Surgery, University of Alabama at Birmingham, 1808 7th Avenue South D202 Boshell Building Birmingham, Alabama 35233, USA; Division of Transplantation, University of Alabama at Birmingham, 701 19th Street South 722 Lyons Harrison Birmingham, Alabama 35233. Electronic address:

Orthotopic liver transplantation (OLT) has many roles in biliary disease. OLT provides excellent results for patients with unresectable hilar cholangiocarcinoma. OLT prolongs survival in primary biliary cirrhosis not responsive to therapy and improves quality of life. Read More

Surg Clin North Am 2019 Apr 10;99(2):357-367. Epub 2019 Feb 10.

Department of Surgery, University of Alabama at Birmingham, 1808 7th Avenue South, BDB 607 Birmingham, AL 35233-3411, USA. Electronic address:

Compared with other periampullary tumors, cancers of the ampulla of Vater are rare. These tumors tend to present earlier than their pancreatic and distal bile duct brethren. In addition to the hypothesis that they are also less biologically aggressive, ampullary cancers tend to have better survival than other types of periampullary cancers. Read More

Surg Clin North Am 2019 Apr 10;99(2):175-184. Epub 2019 Feb 10.

Division of Hepatopancreatobiliary Surgery, Department of Surgery, Atrium Health/Carolinas Medical Center, Charlotte, NC, USA; Division of Hepatopancreatobiliary Surgery, Atrium Health/Carolinas Medical Center - Northeast, 200 Medical Park Drive, Suite 430, Concord, NC 28025, USA. Electronic address:

Acute cholangitis remains a potentially lethal disease if not appropriately diagnosed in a timely fashion. Modern diagnostic and therapeutic modalities have greatly decreased mortality from acute cholangitis. This article aims to provide an up-to-date synopsis of empirically tested diagnostic criteria as well as an overview of the expanding interventions available. Read More

World J Gastrointest Surg 2019 Feb;11(2):53-61

Humanitas Huniversity, Hunimed, Pieve Emanuele, Milano 20090, Italy.

Synchronous biliary and duodenal malignant obstruction is a challenging endoscopic scenario in patients affected with ampullary, peri-ampullary, and pancreatic head neoplasia. Surgical bypass is no longer the gold-standard therapy for these patients, as simultaneous endoscopic biliary and duodenal stenting is currently a feasible and widely used technique, with a high technical success in expert hands. In recent years, endoscopic ultrasonography (EUS) has evolved from a diagnostic to a therapeutic procedure, and is now increasingly used to guide biliary drainage, especially in cases of failed endoscopic retrograde cholangiopancreatography (ERCP). Read More

Endoscopy 2019 Mar 5. Epub 2019 Mar 5.

Humanitas Clinical and Research Center, Digestive Endoscopy Unit, Division of Gastroenterology, Rozzano, Milano, Italy.

Liver Int 2019 Mar 4. Epub 2019 Mar 4.

Department of Medical Oncology, The Christie NHS Foundation Trust, Manchester, UK.

Cholangiocarcinoma (CCA) is a heterogeneous group of tumours, derived from cells of the biliary tree, which represent the second most frequent primary liver tumour. According to the most recent classifications, CCA can be subdivided into intrahepatic (iCCA) and extrahepatic (eCCA) which include perihilar (pCCA) and distal (dCCA) CCA. CCA are usually identified at advanced stages, when the primary tumour grows enough to produce a large liver mass or when jaundice has developed because of biliary tree obstruction. Read More

Georgian Med News 2019 Jan(286):100-106

Iv. Javakhishvili Tbilisi State University, Faculty of Medicine, Al. Natishvili Institute of Morphology, Georgia.

Ductular reaction (DR) is one of the classical features of biliary obstruction in humans as well as in experimental models. It is the histological phenomenon expressed by the increased number of ductular profiles (DPs), which is especially intensively studied in rodents' model of common bile duct ligation (CBDL). However, some issues related with DR in long-term CBDL are not clear enough. Read More

F1000Res 2019 25;8. Epub 2019 Feb 25.

Medicine and Bioengineering, University of Pennsylvania, Philadelphia, PA, 19104, USA.

Biliary atresia (BA) is a neonatal liver disease characterized by progressive obstruction and fibrosis of the extrahepatic biliary tree as well as fibrosis and inflammation of the liver parenchyma. Recent studies found that infants who will go on to develop BA have elevated direct bilirubin levels in the first few days of life, suggesting that the disease starts . The etiology and pathogenesis of BA, however, remain unknown. Read More

J Surg Oncol 2019 Mar 1. Epub 2019 Mar 1.

Division of Surgical Oncology, University of New Mexico Departmeny of Surgery, University of New Mexico Health Science Center, Albuquerque, New Mexico.

Unresectable pancreatico-biliary cancers frequently cause biliary obstruction. Symptomatic management of biliary obstruction is most commonly accomplished with percutaneous or endoscopic drainage. When Nonsurgical means have been exhausted, effective surgical palliation may be performed by way of choledochojejunostomy. Read More

Radiol Case Rep 2019 Apr 13;14(4):495-500. Epub 2019 Feb 13.

Loma Linda University Medical Center, 11234 Anderson St, Loma Linda, CA 92354, USA.

Intraductal papillary mucinous neoplasm of the biliary tract (IPMN-B) is an increasingly recognized pathologic entity characterized by intraluminal papillary masses and increased mucin secretion, resulting in obstruction and dilation of the biliary tree. These lesions, rarely seen in clinical practice in the United States, are now considered to be important precursors for the development of cholangiocarcinoma. Therefore, it is critical that radiologists become familiar with the radiographic manifestations of IPMN-B in order to diagnosis these lesions at a time when surgical resection may be curative. Read More

Dig Endosc 2019 Feb 25. Epub 2019 Feb 25.

Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.

Background And Aim: An antireflux metal stent (ARMS) for nonresectable distal malignant biliary obstruction may prevent recurrent biliary obstruction (RBO) due to the duodenobiliary reflux and prolong time to RBO (TRBO). The superiority of the ARMS over conventional covered self-expandable metal stents (SEMSs) has not been fully examined.

Methods: We conducted a multicenter randomized controlled trial to examine whether TRBO of an ARMS with a funnel-shaped valve was longer than that of a covered SEMS in SEMS-naïve patients. Read More