Journal of Hepato‐Biliary‐Pancreatic Sciences最新文献

Background: Time-in therapeutic range (TTR) is defined as the time a drug concentration remains within the therapeutic range. To explore the optimal management of calcineurin inhibitor (CNI), we investigated how TTR percentage (TTR%) in two different CNI protocols relates to short-term outcomes after living-donor liver transplantation (LDLT).

Methods: TTR% was estimated for two different protocols in 352 adult LDLT recipients over 90 days in this retrospective, single-center study. Short-term outcomes were compared among the TTR% groups in each protocol.

Results: Higher TTR% was associated with better acute rejection-free survival: 96.2%, 86.1%, 74.7%, and 38.9% for TTR% ≥ 60%, ≥ 50%-< 60%, ≥ 40%-< 50%, and < 40%, in the low-target protocol, respectively (p < 0.001, log-rank test); 73.7%, 74.3%, 63.6%, and 48.3%, in the high-target protocol, respectively (p = 0.003). The incidence of adverse events was similar among TTR% groups in each protocol. Multivariate analysis revealed higher TTR% was protective for rejection-free survival, and this trend was particularly pronounced in the low-target protocol.

Conclusions: High TTR%, reflecting well-controlled CNI levels, was associated with better outcomes after LDLT. The outcome of high TTR% in low-target protocol seems better, but further prospective validation is warranted.

Background: Understanding the genetic links between acute pancreatitis (AP) and its infectious comorbidities is crucial for prognosis and therapy, yet remains underexplored.

Methods: We conducted a comprehensive post-GWAS analysis using large-scale summary statistics for AP and 16 infectious diseases. To pinpoint pleiotropic genes, we integrated multi-omics data via transcriptome-wide and proteome-wide association studies, and resolved cell-type-specific effects using single-cell analysis. Extensive locus colocalization analyses were performed to validate our findings by estimating the probability of shared causal variants.

Results: This computational discovery phase prioritized 29 high-confidence pleiotropic genes, including established loci (SPINK1, CRP) and novel candidates (ERBB2, ALDH2, FLOT1). To functionally validate and contextualize these findings, we performed bulk transcriptomic analysis on peripheral blood from AP patients and employed gsMap, a spatial GWAS mapping algorithm, to integrate our genetic data with transcriptomics from a murine AP model, comparing pathological versus normal tissue. These analyses confirmed that the identified genes are dynamically regulated in a severity-dependent manner in patients and are activated within specific pathological niches in pancreatic tissue.

Conclusion: In conclusion, this study provides a genetic map linking AP and its infectious comorbidities, offering insights into potential prevention strategies and highlighting novel therapeutic targets for further investigation and validation.

Purpose: To investigate the trajectory of the learning curve of single-port laparoscopic choledochal cyst excision and Roux-en-Y hepaticojejunostomy (SPCH), and to assess the determinants influencing the duration of the surgical procedure.

Methods: A prospective observative cohort was established from March 15, 2020 to May 1, 2025 to analyze the learning curve of SPCH, utilizing the cumulative sum method (CUSUM). Demographic data, imaging information, surgical details, postoperative imaging findings, and other follow-up information were recorded; multiple linear regression analysis was performed to identify factors affecting surgical outcomes.

Results: A total of 70 surgeries were completed. CUSUM analysis revealed that a cumulative 29 cases of SPCH were needed to complete the learning curve. Multiple linear regression indicated that longer operative duration was significantly related to more blood loss (β: 2.690, SE: 0.6473, 95% CI: 1.393 to 3.987, p = 0.0001) and the greater diameter of the cyst (β: 12.95, SE: 3.621, 95% CI: 5.692 to 20.20, p = 0.0007).

Conclusion: For a surgeon experienced in conventional laparoscopic choledochal cyst excision, 29 cases were required to complete the learning curve for SPCH. Repeated hemostasis and the dissection of larger cysts can significantly prolong operative duration.

Background/purpose: Accurate assessment of tumor invasion depth is essential for determining the surgical strategy for gallbladder cancer; however, preoperative assessment remains challenging. This study assessed the utility of intraoperative narrow-band imaging (NBI) of the gallbladder serosal surface for estimating tumor invasion depth.

Methods: Thirty-nine patients with suspected gallbladder cancer underwent intraoperative observation of the gallbladder serosa using NBI. The NBI findings were classified based on vascular irregularities and correlated with postoperative histopathological data.

Results: Among the 39 patients, 26 (66.7%) were diagnosed with gallbladder cancer. All patients with positive NBI (n = 14) were pathologically confirmed to have gallbladder cancer. Positive NBI was significantly associated with ≥ T2 invasion and increased microvasculature in the subserosal layer (p < 0.001), as well as with lymphatic invasion (p < 0.001). Diagnostic sensitivities for ≥ T2 invasion were 79.5% for intraoperative NBI, 69.4% for plane CT, and 63.0% for EUS.

Conclusions: Intraoperative NBI may be useful for evaluating tumor depth and lymphatic involvement in patients suspected to have gallbladder cancer, which can support intraoperative surgical decision-making.

With supporting video, Takayama and colleagues demonstrate double-balloon endoscopy-assisted peroral pancreatoscopy-guided electrohydraulic lithotripsy for pancreatic duct stones in a patient with surgically altered anatomy. After balloon dilation of a pancreaticojejunostomy stricture, stones were fragmented under direct pancreatoscopic visualization and successfully removed using a spiral basket, achieving complete ductal clearance.

With supporting video, Oka and colleagues describe endoscopic closure of a blind-end duodenal perforation secondary to postoperative pancreatic fistula in surgically altered anatomy. Using balloon-assisted endoscopy, an 8-mm perforation was successfully closed with through-the-scope Dual Action Tissue™ and MANTIS™ clips, demonstrating a minimally invasive alternative when over-the-scope devices are impractical.