Journal of Hepato‐Biliary‐Pancreatic Sciences最新文献

Background: Recent dynamic changes in the etiology of hepatocellular carcinoma (HCC) have provoked an active discussion on the prognostic factors and better management of HCC patients undergoing surgery, considering the underlying metabolic factors However, little is known about the influence of preoperative habitual alcohol consumption on the clinical outcomes of HCC.

Methods: We investigated the prognostic impact of preoperative alcohol consumption and the etiology of HCC in 1223 patients who underwent surgery for HCC.

Results: Multivariate analysis identified the tumor etiology as being significantly associated with the overall survival, and the preoperative average alcohol consumption as being significantly associated with the recurrence-free survival rate after surgery (hazard ratio [HR], 1.02; 95% CI, 1.00-1.03 per +10 g/day). Hazard estimation also revealed an increased risk of recurrence with increasing preoperative average alcohol consumption, irrespective of the etiology of HCC. Competing-risks regression analysis confirmed that the higher the preoperative average alcohol consumption, the shorter the time-to-interventional failure (HR, 1.03; 95% CI, 1.01-1.05 per +10 g/day) and the worse the disease-specific survival (HR, 1.03; 95% CI, 1.00-1.05 per +10 g/day).

Conclusion: The present analysis suggests that preoperative average alcohol consumption is correlated with the oncological outcomes in patients undergoing surgery for HCC, irrespective of the etiology of HCC.

Background: Postoperative fluid collections (PFCs) are common after left pancreatectomy (LP), but their definition and incidence remain unclear.

Methods: A systematic search was performed for studies published up to April 2025 reporting the incidence of PFCs after LP. PFCs were defined as radiologically detected collections within 90 days after surgery; symptomatic PFCs were those associated with clinical symptoms, infections, or requiring intervention. The primary outcome was the pooled incidence of overall and symptomatic PFCs.

Results: Twenty-six studies (5 RCTs and 21 observational cohorts) were analyzed. Three RCTs reported overall PFCs and the pooled incidence was 47.9% (95% CI 32.2-64.1; I² = 94.0%). All five RCTs reported symptomatic PFCs, with a pooled incidence of 9.6% (95% CI 7.6-12.0; I² = 35.5%). Eighteen observational studies analyzed overall PFCs with a pooled incidence of 58.3% (95% CI 44.2-71.2; I² = 97.7%), while symptomatic PFCs were reported in 19 cohorts with a pooled incidence of 15.0% (95% CI 11.7-19.1; I² = 91.7%).

Conclusion: PFCs incidence after LP approaches 50% overall and 10%-15% for symptomatic collections. Consistency was observed only in RCTs reporting symptomatic PFCs. Standardized, radiology-based definitions are urgently needed to improve comparability across studies and to guide.

Background/aim: Accurate prediction of pancreatic necrosis remains critical in acute pancreatitis. This study aimed to identify early predictors of necrosis and externally validate the previously derived Necrosis Development Score-48 (NDS-48).

Methods: This prospective cohort study included patients with edematous acute pancreatitis confirmed by contrast-enhanced CT. Patients were followed for 3-6 months to monitor necrosis development, and associated factors were identified. The predictive performance of NDS-48 was evaluated, and cumulative probabilities by risk category were estimated using Kaplan-Meier analyses. Sensitivity analyses assessed the robustness of the findings.

Results: Necrosis developed in 39 (15.9%) of 246 patients during follow-up. Of these, 27 (69.2%) had walled-off necrosis and 11 (28.2%) had infected pancreatic necrosis. White blood cell count, lactate dehydrogenase, C-reactive protein, and albumin at 48 h were significant predictors, forming the basis of the modified NDS-48. The area under the curve for NDS-48 and modified NDS-48 was 0.947 (95% CI, 0.918-0.976) and 0.965 (0.942-0.988), respectively. Necrosis occurred in only one low-risk patient, while over three-quarters of high-risk patients developed necrosis. Sensitivity analyses yielded similar results.

Conclusions: NDS-48 and its modified version demonstrated excellent diagnostic accuracy for predicting necrosis and allow early risk stratification in patients with edematous acute pancreatitis.

Background: The diagnostic performance of clinical diagnostic criteria for IgG4-related sclerosing cholangitis 2020 (IgG4-SC2020) has not been fully validated since its proposal as a revision of the 2012 criteria (IgG4-SC2012).

Methods: We conducted a multicenter validation study to evaluate the diagnostic performance of IgG4-SC2020 using clinical data collected from 1034 patients with IgG4-SC and 447 patients with mimickers, including 143 with pancreatic cancer, 157 with primary sclerosing cholangitis, and 147 with cholangiocarcinoma in Japan.

Results: The sensitivity of IgG4-SC2020 was significantly higher than that of IgG4-SC2012 (99.0% vs. 89.1%; p < 0.001). The specificities of both IgG4-SC2020 and IgG4-SC2012 were 100% for pancreatic cancer and cholangiocarcinoma. For primary sclerosing cholangitis, the specificities of IgG4-SC2020 and IgG4-SC2012 were 97.5% and 100%, respectively, with no significant difference (p = 0.123). A total of 113 patients who could not be diagnosed according to the IgG4-SC2012 were successfully diagnosed using IgG4-SC2020. These diagnostic improvements were attributed to the inclusion of MRCP findings (n = 97), the absence of neoplastic cells on histology (n = 15), and the presence of IgG4-related kidney lesions (n = 1).

Conclusions: This Japanese multicenter validation study demonstrated that the diagnostic performance of IgG4-SC2020 was superior to that of IgG4-SC2012.

Trial registration: UMIN Clinical Trials Registry (UMIN-CTR), UMIN000052984.

Background: Recently, surgical resection has been attempted for postoperative recurrence of pancreatic ductal adenocarcinoma (PDAC). This multicenter study aimed to investigate whether resection of any recurrent lesion contributes to the survival of patients with PDAC.

Methods: This retrospective study of the Hepato-Pancreato-Biliary Scientific Network for Clinical Oncology Research Working Cohort involved patients with resectable/borderline resectable PDAC who underwent surgery between 2013 and 2019 and who subsequently developed recurrence after resection of the primary PDAC. A time-dependent Cox regression model adjusted for various patient background and clinicopathological factors was used.

Results: The study cohort comprised 1527 patients; 96 underwent resection for recurrence, including hepatectomy in 12 patients, pneumonectomy in 40, and pancreatectomy in 42. Overall survival after the initial treatment of primary PDAC was significantly better in patients who underwent resection compared with those who did not (75.0 vs. 25.8 months). The time-dependent Cox regression model indicated that pneumonectomy for lung metastasis (HR = 0.12) and pancreatectomy for recurrence in the pancreatic remnant (HR = 0.20) significantly affected overall survival, whereas hepatectomy for liver metastasis was not (HR = 0.46).

Conclusion: Resection for postoperative recurrence of PDAC may offer survival benefits for selected patients, especially for lung metastasis and residual pancreatic recurrence.

Trial registration: https://ClinicalTrials.gov identifier: UMIN000049664.

Background: Despite advances in understanding the risk factors of post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP), this adverse event remains frequently unpredictable. This study aims to develop a machine learning (ML) model to predict PEP risk.

Methods: Data were collected from a prospective ERCP registry on patients with naïve papilla who underwent ERCP between 2022 and 2024. CatBoost and eXtreme Gradient Boosting algorithms were trained to estimate PEP risk and the performance of the resulting models was assessed using the area under the receiver operating characteristic (AUC) with 10-fold cross-validation.

Results: Of 1330 screened patients, 1190 met the inclusion criteria, and 170 (14.3%) developed PEP. The best-performing algorithm was CatBoost, which consisted of eight features: age, sex, normal papilla morphology, pancreatic duct cannulation, difficult cannulation, abnormal bilirubin levels, common bile duct diameter, and successful stone extraction. This model achieved an AUC of 68.8% (70.4% sensitivity, 67.2% specificity, 26.5% positive predictive value, and 92.0% negative predictive value). The CatBoost model effectively stratified patients into low-, intermediate-, and high-risk groups, with corresponding PEP incidences of 5.7%, 21.0%, and 40.0%, respectively.

Conclusions: ML is highly promising for prediction of PEP. Future studies should focus on multicenter data, inclusion of multimodal data, severity risk-stratification, and real-time application.

Introduction: Various guidelines recommend endoscopic stone removal for asymptomatic common bile duct stones (CBDS); however, previous studies have indicated that asymptomatic CBDS is associated with a higher incidence of post-ERCP pancreatitis (PEP). Our study aimed to compare the clinical outcomes of ERCP between elderly patients with asymptomatic and symptomatic CBDS.

Methods: Elderly patients with CBDS were divided into two groups: A (asymptomatic CBDS) and S (symptomatic CBDS). Propensity score matching was performed to reduce possible bias in the baseline characteristics between the two groups, yielding 221 matched patients. Primary outcomes included early adverse events (AEs) during ERCP, while secondary outcomes included technical success rate and late AEs.

Results: Regarding ERCP-related early AEs, the incidence of PEP was 6.3% in group A and 4.5% in group S, with no significant difference between the groups. The technical success rates were 87.8% and 84.6% in groups A and S, respectively, with no significant difference. The most common late AE was the recurrence of CBDS (11.3% in group A versus 18.6% in group S [p = 0.04]); Kaplan-Meier analysis also revealed a tendency toward a higher cumulative incidence in group S.

Conclusion: Endoscopic transpapillary stone extraction in asymptomatic elderly patients may be beneficial.