Journal of Hepato‐Biliary‐Pancreatic Sciences最新文献

Objectives

Remimazolam is a novel, ultra-short-acting benzodiazepine. Remimazolam is characterized by rapid induction and recovery and low cardiopulmonary effects. The present study aimed to examine the safety and efficacy of a sedation method combining remimazolam and pentazocine during endoscopic retrograde cholangiopancreatography (ERCP) in a Japanese cohort.

Methods

The present investigation was a single-center, single-arm, Phase 2 study. The primary endpoint was successful endoscopic sedation. The initial dose was induced with remimazolam (0.1 mg/kg) and pentazocine (3.75 mg). Remimazolam (0.05 mg/kg) and the same dose of pentazocine as the initial dose were added as needed in response to body movements or signs of discomfort during the procedure.

Results

A total of 59 patients [median age (range): 75 years (48–87 years), 47 male (79.7%)] were enrolled. Successful endoscopic sedation was achieved in all patients. One patient (1.7%) experienced transient circulatory depression, with no instances of respiratory depression or need for flumazenil reversal. Post-procedure alertness was achieved within 5 and 10 min in 52 (88.1%) and 58 patients (98.3%), respectively.

Conclusion

Sedation with remimazolam and pentazocine in ERCP demonstrated high efficacy and a favorable safety profile in the Japanese population.

Trial Registration

This trial was registered in the Japan Registry of Clinical Trials (jRCTs051230088)

Background

Risk factors of symptomatic venous gas embolism (GE) during laparoscopic liver resection (LLR) are poorly known. The objective of this study was to report the incidence, risk factors, and morbidity of symptomatic GE during LLR.

Methods

All consecutive patients who underwent LLR in 3 French centers over 3 years were retrospectively studied. All intraoperative events, with a focus on symptomatic venous GE, were collected and reviewed.

Results

Among the 518 LLR (507 patients) studied, 26 (5%) cases of symptomatic GE occurred. There was no GE-related death nor neurological sequelae after GE. The group of patients with GE and without GE was similar in terms of baseline characteristics, type of resection, and pneumoperitoneum pressure (≤ 12 mmHg in 93% of LLR) or intraoperative bleeding. Overall morbidity and length of stay were longer after GE. The probability of GE was higher under the Airseal insufflation system at 12 mmHg (7.1% with Airseal versus 0.59% with conventional systems, odds ratio 12.73, 95% confidence interval [2.66–228.4], p = 0.013).

Conclusion

Our results suggest that AirSeal at 12 mmHg or more is a risk factor for symptomatic venous GE. Insufflation with lower pressure or alternative insufflation systems should be evaluated during LLR.

Background

Few studies have evaluated allografts that were declined before the acceptance for deceased-donor liver transplantation. We aimed to elucidate the characteristics of these allografts and assess their transplantation outcomes.

Methods

We analyzed data from 730 adult liver allografts transplanted between July 2010 and March 2024. Clinical characteristics of the transplanted allografts were evaluated according to the number of declines, and the outcomes of the recipients were analyzed.

Results

Transplanted allografts were categorized into three groups: ≥ 5 declined (n = 41), 1–4 declined (n = 104), and no declined group (n = 585). The ≥ 5 declined group exhibited high liver enzyme levels and steatosis. Within this group, the Japan Risk Index and total ischemic time (TIT) were identified as poor prognostic factors. Notably, in cases where TIT exceeded 10 h, a poor prognosis was observed in the ≥ 5 declined group.

Conclusion

Abnormal liver functions or steatosis were observed in the ≥ 5 declined group. Shortening the TIT could contribute to an improved prognosis after transplantation.

Background

Enterococci are commonly isolated from bile cultures in patients with acute cholangitis (AC) and pose a global concern owing to antibiotic resistance. This study identified predictive factors and clinical characteristics of AC with enterococcal-positive bile cultures.

Methods

Consecutive patients with AC and bactobilia who underwent endoscopic retrograde cholangiopancreatography between April 2022 and March 2024 were included. Patients were categorized into enterococcal (E) and non-E groups based on bile culture results. Predictive factors for enterococcal positivity were analyzed. Empirical antibiotic coverage and clinical outcomes (symptom duration, length of antibiotic therapy, in-hospital mortality, and short-term recurrence) were compared within all-grade and severe AC.

Results

Among 250 patients, 100 with enterococcal-positive bile cultures formed the E group. Predictive factors included age > 71 years, immunosuppressed status, prior endoscopic sphincterotomy, and prior biliary stenting. Inappropriate empirical antibiotic coverage was more frequent in the E group across both severity categories. Clinical outcomes did not differ among all-grade patients except for higher short-term recurrence in the E group. No significant differences were observed among severe patients for any clinical outcome.

Conclusions

Enterococcal-positive bile cultures are predicted by specific factors. Despite frequent inadequate empirical antibiotic coverage, most clinical outcomes were similar to those for non-enterococcal patients.

Background

The Warshaw technique for spleen-preserving distal pancreatectomy (SPDP), which sacrifices splenic vessels, is widely used for benign and borderline malignant pancreatic diseases due to its technical simplicity. However, it carries the risk of splenic infarction.

This study aimed to evaluate the incidence, risk factors, and clinical course of splenic infarction in patients who underwent SPDP using the Warshaw technique.

Methods

Patients who underwent SPDP using the Warshaw technique at the Samsung Medical Center between 2007 and 2022 were retrospectively analyzed. Postoperative computed tomography scans were reviewed by a single researcher to classify splenic infarction severity based on the extent of infarction.

Results

About 158 patients underwent the Warshaw technique. Splenic infarction was observed in 75 patients (47.5%). Among these, 34 cases (21.5%) were classified as severe (> 50%) infarction.

Univariate and multivariate analysis identified previous abdominal surgery as the only statistically significant risk factor. Among the 75 patients with splenic infarction, two required antibiotic management, while none required radiological intervention.

Conclusion

Splenic infarction after SPDP using the Warshaw technique was clinically insignificant. These findings support the use of the Warshaw technique as a feasible and effective option for treating benign and borderline malignant pancreatic diseases.