Journal of Hepato‐Biliary‐Pancreatic Sciences最新文献

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.

Background/Purpose

Systemic lupus erythematosus (SLE) may impact surgical outcomes of acute cholecystitis due to immune dysfunction and systemic inflammation. This study evaluated short-term outcomes of cholecystectomy in SLE patients using US Nationwide Readmissions Database data.

Methods

Adults (≥ 18 years) admitted with acute cholecystitis who underwent cholecystectomy between 2016 and 2020 were included. Patients with cholecystostomy or missing data were excluded. After 1:4 propensity score matching, multivariable logistic regression assessed associations between SLE and postoperative outcomes, with results reported as adjusted odds ratios (aORs).

Results

A total of 4400 patients were analyzed (880 with SLE; 3520 without). SLE was associated with higher odds of complications (aOR = 1.64, 95% CI: 1.30–2.08, p < 0.001), particularly sepsis (aOR = 2.41, 95% CI: 1.55–3.77, p < 0.001) and acute kidney injury (aOR = 1.64, 95% CI: 1.23–2.18, p = 0.001). SLE patients also had increased 30-day (aOR = 1.59, 95% CI: 1.24–2.03, p < 0.001) and 90-day (aOR = 1.61, 95% CI: 1.31–1.99, p < 0.001) readmission rates, longer hospital stays (β = 1.04 days), and higher costs (β = 13.01, 95% CI: 7.23–18.80, p < 0.001).

Conclusions

SLE is independently linked to worse short-term outcomes following cholecystectomy for acute cholecystitis. Tailored perioperative strategies are warranted for this high-risk group.

Background

Congenital biliary dilatation (CBD) is a rare anomaly often treated surgically, yet postoperative complications remain a concern. This study aimed to evaluate the incidence, timing, and risk factors of such complications after CBD surgery.

Methods

A retrospective review was conducted on 184 patients with CBD who underwent either open or laparoscopic surgery, with a mean follow-up of 9 years. The analysis focused on postoperative complications, including bile duct–related issues, pancreatic complications, and bowel obstruction.

Results

Complications occurred in 14.7% of patients, predominantly bile duct–related (11.4%), followed by pancreatic (1.6%) and bowel obstruction (1.6%). Most bile duct complications, including anastomotic and intrahepatic strictures, emerged within 5 years postoperatively. Residual bile ducts were more common after open surgery, but no significant difference in other complications was observed between surgical approaches. No biliary malignancies developed during follow-up.

Conclusion

The majority of complications occurred within 5 years after surgery, underscoring the importance of intensive monitoring during this period. Regular imaging and blood tests are essential for early detection. Although no malignancies were observed, long-term follow-up remains critical to address late-onset risks.

Trial Registration: Clinical registration number: 2023-045432262

Background

Despite advances in surgical techniques, postoperative pancreatic fistula (POPF) remains a major concern after pancreatoduodenectomy (PD). Although various risk factors have been identified, most are patient-specific and nonmodifiable. This study investigated whether the time from pancreatic division to anastomosis (division-to-anastomosis time, DAT) influences postoperative outcomes.

Methods

We retrospectively analyzed 182 patients who underwent PD for nonpancreatic cancer between 2017 and 2022. The relationship between DAT and drain amylase (D-amy) levels on postoperative day 3 was evaluated. We also investigated the association between DAT and POPF development. Multiple regression analyses were performed to adjust for potential confounding factors.

Results

Median patient age was 72 years, and 64.8% were male. Primary diagnoses included distal bile duct (35.7%), ampullary (24.7%), and duodenal (7.7%) cancers. Longer DAT was independently associated with increased D-amy levels (regression coefficient 0.16, 95% confidence interval: 0.0–0.29), with each hourly increase in DAT corresponding to a 1.45-fold increase. Grade B POPF occurred in 48% of cases. Multivariate analysis identified prolonged DAT and higher BMI as independent POPF risk factors.

Conclusions

Prolonged DAT during PD was associated with increased D-amy levels and POPF incidence. As a modifiable surgical factor, DAT represents a potential target for technical refinement to improve postoperative outcomes.

Background

Effective pain management is essential for patients undergoing pancreaticoduodenectomy (PD) due to the complexity of the surgery. Opioid analgesics (OA) are commonly used for pain relief but can lead to prolonged postoperative use, posing significant health risks. This study examines the incidence and risk factors of prolonged OA use among opioid-naive patients following PD.

Methods

This retrospective cohort study included patients who underwent PD from 2010 to 2022 at National Taiwan University Hospital, excluding those with preoperative opioid use, emergent PD, minimally invasive procedures, opioid dependence, or in-hospital death. Prolonged OA use was defined as filling at least one OA prescription between 31 and 60 days postoperatively. Statistical analyses included univariate and multivariate logistic regression models to identify risk factors.

Results

Among the 1309 patients, 224 (17.1%) filled at least one OA prescription between 31 and 60 days after PD. Multivariate analysis identified BMI (OR = 1.06, 95% CI = 1.02–1.10, p = 0.001), chronic pancreatitis (OR = 1.82, 95% CI = 1.13–2.94, p = 0.013), and epidural analgesia use (OR = 2.40, 95% CI = 1.64–3.52, p < 0.001) as factors associated with prolonged OA use.

Conclusion

This study reveals a 17.1% incidence of prolonged OA use among opioid-naive patients post-PD. These findings highlight the need for tailored pain management strategies to reduce prolonged opioid use and improve patient outcomes. Further research should focus on developing targeted interventions to mitigate opioid dependency in this population.

Background

Overexpression of human epidermal growth factor receptor 2 (HER2) is a recognized prognostic marker and therapeutic target in oncology. However, its clinical significance in intraductal papillary neoplasm of the bile duct (IPNB) remains unclear.

Methods

This retrospective study reviewed patients who underwent resection for IPNB between 1998 and 2011. HER2 overexpression was evaluated by immunohistochemistry and semi-quantitatively categorized into four grades (score 0, 1+, 2+, 3+); the former two and the latter two grades defined HER2-negative and HER2-positive groups, respectively.

Results

A total of 184 IPNB cases were analyzed, of which 12 patients (6.5%) were diagnosed with HER2-positive disease. There were no significant differences between the groups in clinicopathologic characteristics such as tumor location, histologic type, or invasion depth, with the exception of superficial extension, which was significantly more frequent in the HER2-positive group. The HER2-positive group demonstrated significantly worse overall survival than the HER2-negative group (25% vs. 49% at 5 years, p = 0.030). In multivariable analysis, HER2 positivity, age ≥ 70, percutaneous transhepatic biliary drainage, nodal metastasis, and positive margin status were identified as independent prognostic factors.

Conclusion

HER2 overexpression is an independent biologic marker for unfavorable survival, though infrequent in IPNB.