Journal of Hepato‐Biliary‐Pancreatic Sciences最新文献

Background: The impact of extrapancreatic infections (EPI) on outcomes of acute pancreatitis has received limited attention in the literature. We compiled data from published studies to present high-quality evidence on the prognostic role of EPI on acute pancreatitis.

Methods: This PRISMA-compliant and PROSPERO registered review (CRD42024516872) searched Embase, Scopus, Web of Science, and PubMed for comparative studies between EPI and no-EPI. Outcomes assessed were mortality, intensive care unit (ICU) admission, necrosis, organ failure, persistent organ failure, and length of hospital stay (LOS).

Results: Seven studies were included in the review. The meta-analysis found that patients with EPI had a significantly higher risk of mortality as compared to the no-EPI group (OR: 3.85 95% CI: 2.79, 5.31). The risk of ICU admission (OR: 12.24 95% CI: 3.56, 42.10), necrosis (OR: 3.50 95% CI: 1.37, 8.89) organ failure (OR: 6.03 95% CI: 3.75, 9.70) and persistent organ failure (OR: 6.72 95% CI: 3.58, 12.62) was significantly increased in the EPI group compared to the non-EPI group. The meta-analysis also found significantly longer LOS in the EPI group (MD: 11.92 95% CI: 4.75, 19.08).

Conclusion: EPI is associated with a worse prognosis in acute pancreatitis. EPI was associated with an increased risk of mortality, ICU admission, organ failure, and prolonged LOS. Limited number of studies and baseline confounding are drawbacks of current evidence which need to be rectified by future studies.

Background: Hemihepatectomy with extrahepatic bile duct resection is considered the only curative treatment for perihilar cholangiocarcinoma. The aim of the study was to clarify the survival benefits in this invasive surgical procedure for elderly patients.

Methods: A total of 290 patients who underwent surgical resection for perihilar cholangiocarcinoma in our department from 2000 to 2020 were categorized into the E group (62 patients aged ≥75 years) and NE group (228 patients aged <74 years).

Results: The E group exhibited decreased pathological lymph node metastasis (p = .001) and had a shorter operative time (p = .021) and fewer cases of combined vascular resection (p = .002). We found no significant differences in postoperative mortality; however, disease-specific survival was significantly better in the E group (3-year survival: 75.6 vs. 60.3%, p = .031). After propensity score matching, overall survival and disease-specific survival did not differ between the two groups; nevertheless, the hospital mortality rate was significantly higher in the E group (11.5 vs. 1.6%, p = .020). In the E group, a high preoperative Glasgow prognostic score was the only factor associated with hospital mortality (odds ratio, 7.35; p = .026) and indicated worse prognosis.

Conclusions: A high preoperative Glasgow prognostic score was associated with hospital mortality and poor prognosis in elderly patients with perihilar cholangiocarcinoma.

Background/purpose: Fetal hilar cyst is primarily diagnosed as two diseases after birth, cystic biliary atresia (CBA) and choledochal cyst (CC). The aim of our study was to explore more reliable indicators in early differential diagnosis of these cysts.

Methods: We recruited a total of 50 cases with a prenatal diagnosis of hepatic cyst at three centers, and patients were divided into a CBA group (n = 16) and CC group (n = 34) according to postnatal intraoperative diagnosis. Patient features, maximal cyst diameter as measured by prenatal and early postnatal ultrasonography were analyzed and compared between the two groups, as was the effect of cyst size in predicting CBA.

Results: The maximal cyst diameters in the last prenatal ultrasound (LPU) measurement and initial postnatal ultrasound (IPU) in the CBA group were significantly smaller than in the CC group, as was the difference between the IPU and the first prenatal ultrasound (FPU) (i.e., IPU-FPU) in the CBA group relative to the CC group. The IPU-FPU difference showed the best diagnostic performance as a single parameter (AUC, 0.9806), with a sensitivity and specificity of 100% and 90.3%, respectively, and a cutoff value of 7.5 mm.

Conclusion: Ultrasonographic measurement of the maximal cyst diameter can assist in early (within 1 week after birth) identification of CBA. An IPU-FPU <7.5 mm suggested a higher possibility of a postnatal diagnosis of CBA.

Background/purpose: Insufficient studies exist on capnography efficacy during endoscopic ultrasound or endoscopic retrograde cholangiopancreatography, and no definitive conclusions have been drawn. To evaluate the feasibility and efficacy of a novel mainstream capnography using an over-the-biteblock end-tidal CO₂ (EtCO₂) detector in decreasing the risk of hypoxemia during endoscopic ultrasound (EUS) and endoscopic retrograde cholangiopancreatography (ERCP).

Methods: Patients undergoing EUS or ERCP with conscious sedation at a single Japanese center were randomized to a control or a novel capnography monitored (intervention) group in a 1:1 ratio. Hypoxemia correction maneuvers were pursued if the oxygen saturation decreased to <92% in the control or intervention group and if a 15-s suspension of EtCO₂ wave occurred in the intervention group. The primary outcome was the incidence of hypoxemic events, defined as oxygen saturation <90%, during the procedures. Secondary outcomes included technical feasibility of EUS and ERCP with the use of this novel over-the-biteblock monitor.

Results: In total, 250 patients were enrolled without dropouts or missing data (control group: 125; capnography group: 125). There was no significant difference in the incidence of hypoxemia between the control and capnography groups (29.6% [37/125] vs. 26.4% [33/125]; p = .573). The estimated odds ratio was 0.925 (95% confidence interval: 0.708-1.208). The EtCO₂ concentration was successfully captured without impeding endoscopic maneuvers from the beginning to the end of the procedure in all patients.

Conclusions: Although the novel mainstream capnography with an over-the-biteblock EtCO₂ detector captures the EtCO₂ concentration in EUS or ERCP under conscious sedation, it does not lead to the prevention of hypoxemia.

Background: This network meta-analysis (NMA) aims to provide evidence-based guidance for selecting the second-line chemotherapy for biliary tract cancer (BTC).

Methods: A comprehensive literature search was conducted on PubMed, Cochrane, and EMBASE through July 2024. Inclusion criteria involved: (1) patients underwent second-line chemotherapy following platinum-based first-line therapy, (2) intervention/comparator groups consisted of various chemotherapeutic agents, and (3) outcomes measured as hazard ratio (HR) of overall survival (OS) and progression-free survival (PFS) in randomized controlled trials (RCTs) and cohort studies.

Results: Outcomes were measured as HR of OS and PFS in RCTs and cohort studies. The eight studies consisting of 1621 patients were selected. In the NMA for OS, 5FU_plus_Plat (fluorouracil plus oxaliplatin or cisplatin; HR 0.52, 95% confidence interval [CI]: 0.30-0.91), nal-IRI_5FU_LV (nano-liposomal irinotecan plus fluorouracil and LV; HR 0.54 [95% CI: 0.32-0.92]), and FOLFOX (fluorouracil plus oxaliplatin; HR 0.69 [95% CI: 0.50-0.96]) demonstrated significant benefits in OS when compared to control. For PFS, nal-IRI_5FU_LV (HR 0.61 [95% CI: 0.44-0.85]) provided a significant advantage over 5FU.

Conclusions: Second-line chemotherapy for BTC after the failure of gemcitabine plus platinum as first-line therapy, nal-IRI_5FU_LV appears to be the most promising second-line therapy in terms of both OS and PFS.