Journal of Hepato‐Biliary‐Pancreatic Sciences最新文献

Background: The choice between 22-gauge endoscopic ultrasound-guided fine-needle biopsy (EUS-FNB) and EUS-guided fine-needle aspiration (EUS-FNA) for histological diagnosis of type 1 autoimmune pancreatitis (AIP) is unclear. We retrospectively examined the detection rate of histological findings for AIP using EUS-FNA/FNB.

Methods: Patients diagnosed with type 1 AIP using EUS-FNB (Franseen needle) or EUS-FNA (conventional needle) with 22-gauge needles at our hospital between 2012 and 2023 were included in this study. AIP was diagnosed according to International Consensus Diagnostic Criteria (ICDC). The detection rates of level 1 findings, which included storiform fibrosis and/or obliterative phlebitis, and level 2 histological findings were evaluated according to the ICDC.

Results: The EUS-FNB and EUS-FNA groups included 25 and 24 patients, respectively. No significant differences in patient background were noted between the two groups. The detection rates of prominent filtration of lymphocytes and plasma cells along with fibrosis were 56.0% in the EUS-FNB group and 12.5% in the EUS-FNA group (p = .001). The detection rates of more than 10 IgG4-positive plasma cells per high-power microscopic field were 68.0% and 29.2% in the EUS-FNB and EUS-FNA groups, respectively (p = .007). The histological findings for levels 1 and 2 were significantly higher in the EUS-FNB group (56.0% vs. 12.5%; p = .001). Mild pancreatitis was observed in the EUS-FNB group; however, no other serious adverse events occurred.

Conclusion: The 22-gauge EUS-FNB yielded a higher rate of histological findings than 22-gauge EUS-FNA, suggesting that 22-gauge EUS-FNB is suitable and safe for the histological diagnosis of type 1 AIP.

Background: Nonexpert endoscopists cannot achieve high-quality performance during difficult biliary cannulation, representing a significant challenge; precutting is an effective approach for managing these cases. Transpancreatic biliary sphincterotomy (TPBS) is considered more effective than needle-knife precutting owing to its wire-guided technique, which may be suitable for nonexpert endoscopists; however, comparisons between nonexpert and expert endoscopists performing TPBS are not well documented.

Methods: Consecutive patients who underwent TPBS between January 2010 and April 2024 were evaluated. Rates of successful biliary duct cannulation, time to TPBS and bile duct cannulation, and adverse events were compared between both groups. Logistic regression analysis was conducted to identify factors associated with successful bile duct cannulation using TBPS.

Results: The study included 140 patients (77 and 63 in the nonexpert and expert groups, respectively). The rates of successful biliary cannulation and overall adverse events (including pancreatitis, 9.1% vs. 9.5%) were 88.3% and 93.7% (p = .38) and 15.6% and 9.5% (p = .32) in the nonexpert and expert groups, respectively. Multivariate analysis revealed that early TPBS (<22 min) was a significant predictive factor for successful bile duct cannulation.

Conclusions: TBPS may be an effective technique for nonexpert endoscopists; additionally, early TPBS is a significant predictive factor for successful bile duct cannulation.

Globally, antibiotic resistance is linked to increased morbidity, mortality, and healthcare costs, which necessitates further research on optimal antibiotic usage. Acute cholangitis (AC), a common cause of community-acquired bacteremia, often requires antimicrobial therapy. Therefore, studying the appropriate use of antibiotics for AC is considered crucial for suppressing the emergence of resistant bacteria and reducing adverse antibiotic-associated events. The Tokyo Guidelines 2018 (TG18) recommend 4–7 days of antibiotics post-biliary drainage. However, this lacks strong evidence and is based primarily on various evidence and expert opinions. Recent retrospective studies advocate for a shorter 1–3-day antibiotic course for AC, thereby prompting a need to reassess the treatment duration to balance therapeutic efficacy and minimize resistance and adverse effects. Choosing the appropriate duration and antibiotics based on susceptibility to pathogens causing cholangitis is important. Awareness of local resistance patterns and understanding patients' risks of resistant pathogens are prerequisite for effective treatment. We must explore the applicability of these guidelines in specific scenarios such as severe AC, positive blood cultures, fever, or hilar biliary obstructions due to malignancy. This comprehensive review considers both the duration and type of antibiotics and aims to enhance treatment outcomes while reducing the risk of resistant bacterial infections.

Background: Immune checkpoint inhibitors are effective to treat hepatocellular carcinoma (HCC) yet only successful in a small part of patients. This study aimed to investigate whether poly-ICLC, an immune stimulant, can enhance the antitumor effects of anti-PD-1 on mouse HCC.

Methods: We established two syngeneic HCC mouse models with BNL cells in BALB/c mice and Hep-55.1 C cells in C57BL/6 J mice. Mice with subcutaneous HCC tumors received one of five treatments: control, anti-PD-1, intratumoral (IT) poly-ICLC, anti-PD-1 plus intramuscular (IM) poly-ICLC, or anti-PD-1 plus IT poly-ICLC. Tumor volumes were measured, CD8+ T lymphocytes in tumors and spleen were analyzed, and interferon-γ activity was assessed by ELISpot. Immune cell types and abundance were evaluated with NanoString nCounter IO360 panels.

Results: Cotreatment with poly-ICLC significantly enhanced the antitumor effects of anti-PD-1, with IT administration being more effective than IM. IT poly-ICLC also induced more significant CD8⁺ T cell infiltration and interferon-γ activity in the tumor and spleen, and more upregulation of both interferon-γ and M1 macrophage signals in the tumor microenvironment while downregulating several cancer-promoting pathways.

Conclusions: Combination therapy with poly-ICLC, especially through IT route, and anti-PD-1 provides significantly greater antitumor effects than anti-PD-1 monotherapy in syngeneic mouse models of HCC.

The Joint Committee for Nationwide Survey on colorectal liver metastasis (CRLM) was established to improve treatment outcomes in patients with CRLM. The aim of this study was to evaluate the transition in the characteristics and treatment strategies of patients with CRLM and to analyze the prognostic factors. The data of 5085 patients newly diagnosed between 2013 and 2017 were compared with those of 3820 patients from 2005 and 2007. In patients who underwent hepatectomy (n = 2759 and 2163), the number of CRLMs was significantly higher and in the 2013–2017 data than in the 2005–2007 data (median 2 vs. 1; p = .005). Overall survival (OS) rates after diagnosis of CRLM after hepatectomy were better in the 2013–2017 data than that in the 2005–2007 data (5-year OS, 62.4% vs. 56.7%, p < .001). Recurrence-free survival (RFS) after hepatectomy was comparable between the groups (5-year RFS, 30.5% vs. 30.7%; p = .068). Multivariate analyses identified age at diagnosis of CRLM ≥70 years, lymph node metastasis of primary lesion, preoperative carbohydrate antigen (CA) 19–9 value >100 U/mL, number of CRLM 2–4, and R2 resection as independent predictors of OS. Synchronous CRLM, concomitant extrahepatic metastasis, lymphatic invasion, lymph node metastasis of primary lesion, preoperative CA19-9 value >100 U/mL, number of CRLM 5–, and nonlaparoscopic approach were selected as that of RFS. Despite having a higher prevalence of advanced stage CRLM in the 2013–2017 patient population compared to the 2005–2007 cohort, prognostic outcomes demonstrably improved in the later period.

Background: With the advent of minimally invasive techniques and enhanced recovery pathways, outpatient surgery is becoming increasingly common, but has not yet been extensively described in liver surgery. The aim of the present study was to analyze the incidence, characteristics, and outcomes of patients undergoing outpatient hepatectomy in the US.

Methods: We utilized the National Surgical Quality Improvement Program (NSQIP) database for patients who underwent laparoscopic or robotic, elective hepatectomy from 2014 to 2021. Patients discharged on postoperative day 0 were assigned to the "same-day discharge" group, otherwise the patient was considered "admitted." Postoperative outcomes were compared with propensity-matched analysis. Multivariate analysis was performed to identify predictors of postoperative LOS (length of stay).

Results: We identified 7279 patients, of which 361 were in the same-day discharge cohort and 6918 were in the admitted cohort. For admitted patients, median postoperative length of stay was three days (SD = 6). Same-day discharge patients tended to be younger (age 59 vs. 62, p = .034) and more often ASA class ≤2 (49% vs. 29%, p < .001). Comorbidities such as hypertension (40% vs. 45%, p = .048) and diabetes (12% vs. 19%, p = .002) were less common in the same-day discharge cohort. On propensity-matched comparison, there was no significant difference in 30-day mortality (p > .9), 30-day readmission (p = .2), and overall postoperative complication rate (p = .2). Predictors of longer postoperative LOS included longer operative time, inpatient hospital status, preoperative transfusion, dependent functional status, and use of neoadjuvant chemotherapy.

Conclusion: Our results indicate that for low-risk patients and uncomplicated cases, same-day discharge after minimally invasive, elective hepatectomy is feasible without compromising patient safety and outcomes.