Journal of Hepato‐Biliary‐Pancreatic Sciences最新文献

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.

In Japan, 5 years have passed since the initiation of precision cancer medicine, and recent data accumulation in familial pancreatic cancer (FPC) and hereditary pancreatic cancer is outstanding. Multigene germline panel tests (MGPTs) have revealed that 7%-18% of patients with pancreatic cancer (PC) harbor pathogenic germline variants (PGVs), almost equal to the levels of breast, ovarian, endometrial, and colorectal cancers, with a higher incidence in FPC (14%-26%). The majority of PGVs seen in PC patients are clinically actionable and associated with homologous recombination (HR) pathways (6%-10%, particularly BRCA1/2 in 5%-6%), and the clinical guidelines recommend or propose genetic testing for all PC patients. Consensus guidelines have been established for most of the hereditary syndromes associated with PC risks, and surveillances of the pancreas and other at-risk organs are recommended for PGV carriers. Hereditary breast and ovarian cancer (HBOC) is the commonest hereditary cancer syndrome that has moderately increasing life-time risks of PC (3%-7% in Western countries); however, recent Japanese research demonstrated a higher risk level (BRCA1: 16%, BRCA2: 14%). Moreover, recent evidence has suggested a risk linkage between PC and ovarian cancer in HBOC pedigrees. High scores of homologous recombination deficiency suggest biallelic dysfunction of BRCA or other HR-related genes, and the likely effectiveness of platinum agents and PARP inhibitors against PCs. Remote counseling and testing are possible option in the future genetic medicine. As PC ranks in the second commonest target of precision cancer medicine in Japan, we must treat the patients and manage their at-risk relatives efficiently.

Background: We performed a retrospective comparative study to clarify the optimal gallbladder drainage method prior to elective cholecystectomy.

Methods: We collected data from the Diagnosis Procedure Combination database about cholecystitis patients who underwent gallbladder drainage prior to cholecystectomy in a subsequent hospitalization between April 2014 and March 2020. We divided the study population into two groups: an endoscopic gallbladder stenting (EGBS) group and a percutaneous transhepatic gallbladder drainage (PTGBD) group. We performed propensity score matching and compared surgical outcomes related to cholecystectomy.

Results: We collected 6306 cases (PTGBD: 6112 cases; EGBS: 194 cases). In propensity score matching, we obtained 193 matched pairs from the study population. Long-term postoperative antibiotics therapy (2 vs. 9; risk ratio 4.7 [95% CI: 1.1-30.9]) was more frequent in the EGBS group than the PTGBD group. There were no significant differences between the two groups for laparotomic cholecystectomy and postoperative bile duct drainage. For reoperation, postoperative abdominal drainage and postoperative blood transfusion, there were few outcome occurrences and effect measures were not obtained.

Conclusion: Gallbladder drainage by EGBS may have more risk of surgical complications related to elective cholecystectomy than PTGBD. There are a few reports on this topic, so further research should be conducted.

Background: Hepatolithiasis frequently presents with recurring cholangitis and complications. Oddi sphincter-preserved cholangioplasty with hepatico-subcutaneous stoma (OSPCHS), introduced in 1993, has shown favorable long-term results. Endoscopic sphincterotomy (EST) is commonly used, but its impact on OSPCHS outcomes remains unclear.

Methods: From January 1993 to June 2021, 254 patients with hepatolithiasis underwent OSPCHS. A total of 31 patients had prior EST (group with EST, n = 31), while 223 did not (group without EST, n = 223). Perioperative and long-term outcomes were compared, and risk factors for stone and cholangitis recurrence were analyzed using a Cox regression model.

Results: The immediate and final stone clearance rates were 67.3% and 81.9%, respectively. Patients with prior EST had higher rates of stone recurrence (57.7% vs. 35.7%, p = .031), shorter stone-free duration (median: 51.5 vs. 112.0 months, p = .001), higher cholangitis recurrence (45.2% vs. 25.6%, p = .023), and shorter cholangitis-free duration (median: 71.0 vs. 134.0 months, p = .006). Multivariable analysis identified bilateral intrahepatic stones (HR: 1.815, p = .010) and prior EST (HR: 3.157, p = .000) as independent risk factors for stone recurrence, whereas combined hepatectomy was a protective factor (HR: 0.448, p = .001). For cholangitis recurrence, male gender (HR: 2.308, p = .001) and EST (HR: 2.241, p = .009) were independent risk factors, while complete stone clearance reduced recurrence risk (HR: 0.423, p = .002).

Conclusion: Prior EST adversely affects the long-term outcomes of OSPCHS. Therefore, in the management of hepatolithiasis, emphasis should be placed on preserving the Oddi sphincter.

Background: Treatment of intrahepatic cholangiocarcinoma (ICC) remains challenging owing to the lack of clear guidelines on surgical resection. The 2021 ICC guidelines have not fully resolved the ongoing debate between surgical and nonsurgical treatment options. This study aimed to identify trends and issues in ICC treatment strategies in the clinical field by surveying the attitudes of hepatobiliary and pancreatic (HBP) surgeons.

Methods: A survey was conducted among 235 board-certified HBP surgeons affiliated with the Japanese Society of Hepato-Biliary-Pancreatic Surgery. This survey explored the perspectives on tumor conditions that define resectable, borderline resectable, and unresectable diseases, focusing on tumor size, number, and vascular invasion.

Results: Notable variability was observed in the criteria for oncological resectability. While 42.1% of the respondents considered a maximum tumor diameter of 5 cm as resectable, 37.5% indicated no size limit for resectability. Opinions regarding the resectability of tumors with lymph node involvement and vascular invasion vary widely, highlighting the need for standardized criteria.

Conclusion: This survey revealed diverse approaches for defining resectability in ICC, emphasizing the necessity for more precise guidelines. Further research and expert consensus are required to establish standardized criteria that can guide clinical decision-making and improve patient outcomes.