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1.
Acta Cytol. 2018;62(4):295-301. doi: 10.1159/000488636. Epub 2018 May 7.

UroVysion Multi-Target Fluorescence in situ Hybridization Assay for the Detection of Malignant Bile Duct Brushing Specimens: A Comparison with Routine Cytology.

Abstract

OBJECTIVE:

Routine bile duct brushing cytology is an important diagnostic tool in the evaluation of bile duct stricture. The purpose of this study was to evaluate the performance of the UroVysion fluorescence in situ hybridization (FISH) assay for the detection of malignant bile duct brushing specimens.

STUDY DESIGN:

Thirty-five bile duct brushing specimens were included in the study. The FISH assay utilized the commercially available UroVysion probes. The indeterminate cytology results were considered as negative for statistical analysis.

RESULTS:

Twenty-two of 35 patients were diagnosed as having malignancy based on tissue diagnosis or clinical progression of disease by image assessment. The sensitivity of routine cytology and FISH for the detection of malignancy was 14% (3/22) and 55% (12/22), respectively (p = 0.003). The specificity of routine cytology and FISH was 100% (13/13) and 62% (8/13), respectively (p = 0.025). The false-positive rate for routine cytology and FISH was 0% (0/13) and 38% (5/13), respectively.

CONCLUSIONS:

Our study shows that FISH is significantly more sensitive than routine cytology for the detection of malignancy in bile duct brushing specimens. However, in our study, the specificity of FISH was poor compared to the excellent specificity of routine cytology. The compromised specificity of FISH may limit its utility in the detection of malignant bile duct brushing specimens.

KEYWORDS:

Bile duct brushing cytology; Bile duct stricture; Fluorescence in situ hybridization

PMID:
29734171
DOI:
10.1159/000488636
[Indexed for MEDLINE]
Icon for S. Karger AG, Basel, Switzerland
2.
Emerg Med Pract. 2018 Apr 2;20(4 Suppl):1-2.

Jaundice in the emergency department: meeting the challenges of diagnosis and treatment [digest].

Author information

1
Assistant Professor of Emergency Medicine, Department of Emergency Medicine, Emory School of Medicine, Atlanta, GA.
2
Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, NY.

Abstract

There are approximately 52,000 visits a year to emergency departments for patients presenting with jaundice. While many of these patients will not have immediately life-threatening pathology, it is essential that the emergency clinician understands the pathophysiology of jaundice, as this will guide the appropriate workup to detect critical diagnoses. Patients who present with jaundice could require intravenous antibiotics, emergent surgery, and, in severe cases, organ transplantation. This issue will focus on the challenge of evaluating and treating the jaundiced patient in the ED using the best available evidence from the literature. [Points & Pearls is a digest of Emergency Medicine Practice.].

PMID:
29634896
[Indexed for MEDLINE]
Icon for EB Medicine
3.
Emerg Med Pract. 2018 Apr;20(4):1-24. Epub 2018 Apr 1.

Jaundice in the emergency department: meeting the challenges of diagnosis and treatment.

Author information

1
Assistant Professor of Emergency Medicine, Department of Emergency Medicine, Emory School of Medicine, Atlanta, GA.

Abstract

There are approximately 52,000 visits a year to emergency departments for patients presenting with jaundice. While many of these patients will not have immediately life-threatening pathology, it is essential that the emergency clinician understands the pathophysiology of jaundice, as this will guide the appropriate workup to detect critical diagnoses. Patients who present with jaundice could require intravenous antibiotics, emergent surgery, and, in severe cases, organ transplantation. This issue will focus on the challenge of evaluating and treating the jaundiced patient in the ED using the best available evidence from the literature.

PMID:
29565526
[Indexed for MEDLINE]
Icon for EB Medicine
4.
Acta Gastroenterol Belg. 2017 Apr-Jun;80(2):249-255.

Percutaneous stenting in malignant biliary obstruction caused by metastatic disease: clinical outcome and prediction of survival according to tumor type and further therapeutic options.

Author information

1
University Hospital of Ghent, Department of Gastroenterology, De Pintelaan 185, 9000 Ghent, Belgium.
2
University Hospital of Ghent, Department of Interventional Radiology, De Pintelaan 185, 9000 Ghent, Belgium.

Abstract

BACKGROUND AND STUDY AIMS:

Obstructive jaundice caused by metastatic disease leads to deterioration of general condition and short survival time. Successful decompression can offer symptom control and enable further treatment with chemotherapy, which can improve survival.

PATIENTS AND METHODS:

Ninety-nine percutaneous transhepatic cholangiography (PTC) procedures with metallic stent placement were performed in 93 patients between 2007 and 2013. Files were retrospectively studied and a review of patients' demographics, clinical and laboratory parameters, treatment and survival was performed. Kaplan-Meier survival analysis with log-rank test was done in function of bilirubin level, tumor type and treatment with chemotherapy.

RESULTS:

Hyperbilirubinemia resolved in 73% of procedures. Median survival time after the procedure was 48 (95%CI 34.8 - 61.1) days. If additional chemotherapy was possible, a median survival of 170 (95%CI 88.5 - 251.4) days was noted versus 32 (95%CI 22.4 - 41.5) days without chemotherapy (p < 0.01). Survival rates greatly differed between primary tumor type, with the largest benefit of PTC in colorectal cancer. In 35 % of the procedures minor or more severe complications were noted. The 30-day mortality was 33%, with 3 procedure related deaths.

CONCLUSION:

PTC with metallic stenting can bring symptom relief and enable further treatment with chemotherapy, which can lead to a longer survival time, especially in colorectal cancer. However, in patients in whom palliative stenting failed to resolve the hyperbilirubinemia survival is short.

KEYWORDS:

chemotherapy; cholangiography; extrahepatic cholestasis; intervendiology; mortality; neoplasm metastasis

PMID:
29560690
[Indexed for MEDLINE]
5.
Biomed Res Int. 2018 Jan 8;2018:3812424. doi: 10.1155/2018/3812424. eCollection 2018.

Prostaglandin E1 Preconditioning Attenuates Liver Ischemia Reperfusion Injury in a Rat Model of Extrahepatic Cholestasis.

Author information

1
Department of Hepatobiliary and Spleen Surgery, Shengjing Hospital Affiliated to China Medical University, Shenyang, Liaoning 110004, China.

Abstract

The aim of this study is to explore the hepatoprotective effect of intraportal prostaglandin E1 (PGE1) on liver ischemia reperfusion (IR) injury using an extrahepatic cholestatic model, observing oxidative stress markers, proinflammatory factors, apoptotic marker proteins, and an adhesion molecule. The extrahepatic cholestatic model was induced by common bile duct ligation. After seven days, rats were subjected to ischemia by Pringle maneuver for 15 min, followed by 1, 6, or 24 h of reperfusion. Prostaglandin E1 (PGE group) or normal saline (NS group) was continuously infused from 15 min before liver ischemia to 1 h after reperfusion. After reperfusion, histopathological evaluation of the liver was performed, as were measurements of bilirubin, biochemical enzymes, oxidative stress markers (GSH and MDA), proinflammatory factors (MPO, TNF-α, and IL-1β), apoptotic marker proteins (Bcl-2 and Bax), and the adhesion molecule (ICAM-1). PGE1 pretreatment attenuated IR injury in extrahepatic cholestatic liver probably by suppressing MDA, MPO, TNF-α, IL-1β, ICAM-1, and Bax levels and improving GSH and Bcl-2 levels. In conclusion, PGE1 protects extrahepatic cholestatic liver from IR injury by improving hepatic microcirculation and reducing oxidative stress damage, intrahepatic neutrophil infiltration, and hepatocyte apoptosis.

PMID:
29511679
PMCID:
PMC5817361
DOI:
10.1155/2018/3812424
[Indexed for MEDLINE]
Free PMC Article
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6.
Pediatr Surg Int. 2017 Dec;33(12):1243-1248. doi: 10.1007/s00383-017-4154-8. Epub 2017 Oct 16.

Sclerosing and obstructive cholangiopathy in biliary atresia: mechanisms and association with biliary innate immunity.

Author information

1
Department of Human Pathology, Kanazawa University Graduate School of Medicine, Kanazawa, 920-8640, Japan. kenichih@med.kanazawa-u.ac.jp.

Abstract

Biliary atresia (BA) is histologically characterized by a progressive, sclerosing cholangitis and the obstruction of extrahepatic bile ducts. In terms of the etiology and pathogenesis of BA, several viral infections consisting of dsRNA, including Reoviridae, have been implicated. Human biliary epithelial cells (BECs) possess an innate immune system consisting of Toll-like receptors (TLRs). BECs have negative regulatory mechanisms of TLR tolerance to avoid an excessive inflammatory response to lipopolysaccharide (LPS), a TLR4 ligand; however, they lack the tolerance to poly(I:C) (a synthetic analog of viral dsRNA), a TLR3 ligand. Treatment with poly(I:C) induces the expression of the apoptosis-inducer TNF-related apoptosis-inducing ligand (TRAIL), along with the antiviral molecule IFN-β1, and reduces the viability of BECs by enhancing apoptosis. In response, surviving BECs increase their expression of various markers, including basic FGF [an epithelial-mesenchymal transition (EMT)-inducer], S100A4 (a mesenchymal marker), and Snail (a transcriptional factor), and decrease that of epithelial markers such as CK19 and E-cadherin before undergoing EMT. Extrahepatic bile ducts in BA infants frequently show a lack of epithelial markers and an aberrant expression of vimentin, in addition to the enhancement of TRAIL and apoptosis. dsRNA viruses may directly induce apoptosis and EMT in human BECs as a result of the biliary innate immune response, supporting the notion that Reoviridae infections may be directly associated with the pathogenesis of cholangiopathies in BA.

KEYWORDS:

Apoptosis; Biliary atresia; EMT; Innate immunity; TLR

PMID:
29039048
DOI:
10.1007/s00383-017-4154-8
[Indexed for MEDLINE]
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7.
Food Chem Toxicol. 2017 Oct;108(Pt A):214-223. doi: 10.1016/j.fct.2017.08.005. Epub 2017 Aug 5.

Hepatoprotective activities of rosmarinic acid against extrahepatic cholestasis in rats.

Author information

1
Center for Geriatrics and Gerontology, Taichung Veterans General Hospital, Taichung City 407, Taiwan; Institute of Clinical Medicine, National Yang-Ming University, Taipei City 112, Taiwan.
2
Institute of Clinical Medicine, National Yang-Ming University, Taipei City 112, Taiwan; Division of Family Medicine, Taichung Veterans General Hospital, Taichung City 407, Taiwan.
3
Department of Veterinary Medicine, National Chung Hsing University, Taichung City 402, Taiwan.
4
Department of Medical Research, Taichung Veterans General Hospital, Taichung City 407, Taiwan.
5
Department of Food and Nutrition, Providence University, Taichung City 433, Taiwan.
6
Department of Medical Research, Taichung Veterans General Hospital, Taichung City 407, Taiwan; Department of Medical Laboratory Science and Biotechnology, China Medical University, Taichung City 404, Taiwan. Electronic address: cjchen@vghtc.gov.tw.

Abstract

Though rosmarinic acid possesses nutritional, pharmaceutical, and toxic properties and shows therapeutic potential on liver diseases, its therapeutic effects against cholestatic liver diseases have not been proven. Using an extrahepatic cholestasis rat model by bile-duct ligation (BDL), daily oral administration of rosmarinic acid showed improvement effects on liver histology, serum biochemicals, ductular reaction, oxidative stress, inflammation, and fibrosis. Rosmarinic acid alleviated BDL-induced transforming growth factor beta-1 (TGF-β1) production and hepatic collagen deposition, and the anti-fibrotic effects were accompanied by reductions in matrix-producing cells and Smad2/3. BDL rats showed increased hepatic NF-κB/AP-1 activities, inflammatory cell infiltration/accumulation, and cytokine production, and these signs of hepatic inflammation were ameliorated by rosmarinic acid. Mechanistic study revealed an inhibitory effect of rosmarinic acid on the axis of the high mobility group box-1 (HMGB1)/toll-like receptor-4 (TLR4) in BDL rats. Results of cultured hepatic stellate cells further showed the impacts of rosmarinic acid which attenuated TGF-β1-induced stellate cell mitogenic and fibrogenic activation. Our findings support the concept that rosmarinic acid could serve as a hepatoprotective agent, and dietary rosmarinic acid supplementation may be beneficial in terms of improving cholestasis-related liver injury via mechanisms involving resolution of oxidative burden and down-regulation of HMGB1/TLR4, NF-κB, AP-1, and TGF-β1/Smad signaling.

KEYWORDS:

Cholestasis; Herbal medicine; Polyphenol; Rosmarinic acid

PMID:
28789951
DOI:
10.1016/j.fct.2017.08.005
[Indexed for MEDLINE]
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8.
Clin Transplant. 2017 Jul;31(7). doi: 10.1111/ctr.13003. Epub 2017 Jun 11.

Long-term outcomes of early compared to late onset choledochocholedochal anastomotic strictures after orthotopic liver transplantation.

Author information

1
Division of Transplantation, Methodist University Hospital Transplant Institute, University of Tennessee Health Science Center, Memphis, TN, USA.
2
Department of Gastroenterology and Hepatology, University of Tennessee Health Science Center, Memphis, TN, USA.
3
Department of Medicine, University of Tennessee Health Science Center, Memphis, TN, USA.
4
Department of Biostatistics and Epidemiology, University of Tennessee Health Sciences Center, Memphis, TN, USA.

Abstract

BACKGROUND:

Endoscopic treatment of anastomotic biliary stricture (ABS) after liver transplantation (LT) has been proven to be effective and safe, but long-term outcomes of early compared to late onset ABS have not been studied. The aim of this study is to compare the long-term outcome of early ABS to late ABS.

METHODS:

Of the 806 adult LT recipients (04/2006-12/2012), 93 patients met the criteria for inclusion, and were grouped into non-ABS (no stenosis on ERCP, n=41), early ABS (stenosis <90 days after LT, 18 [19.3%]), and late ABS (stenosis ≥90 days after LT, 34 [36.5%]). A propensity matched control group for the ABS group (n=42) was obtained matched for outcome variables for age, gender, and calculated MELD score at listing.

RESULTS:

Mean number of ERCPs (2.33±1.3 vs 2.56±1.5, P=.69) were comparable between the groups; however, significantly better long-term resolution of the stricture was noted in the early ABS group (94.44% vs 67.65%, P=.04). Kaplan-Meier analysis revealed worst survival in the early ABS group compared to the non-ABS, late ABS, and control groups (P=.0001).

CONCLUSION:

LT recipients with early ABS have inferior graft survival despite better response to endoscopic intervention.

KEYWORDS:

ERCP; biliary anastomosis; biliary stricture; hepatitis C; liver transplant

PMID:
28489291
DOI:
10.1111/ctr.13003
[Indexed for MEDLINE]
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9.
BMC Surg. 2017 Apr 11;17(1):35. doi: 10.1186/s12893-017-0235-9.

Atorvastatin does not protect against ischemia-reperfusion damage in cholestatic rat livers.

Author information

1
Department of Surgery, Surgical Laboratory, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands. jim.wiggers@gmail.com.
2
Department of Surgery, Surgical Laboratory, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
3
Department of Pathology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
4
Department of Surgery, Surgical Laboratory, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands. m.heger@amc.nl.

Abstract

BACKGROUND:

Extrahepatic cholestasis sensitizes the liver to ischemia/reperfusion (I/R) injury during surgery for perihilar cholangiocarcinoma. It is associated with pre-existent sterile inflammation, microvascular perfusion defects, and impaired energy status. Statins have been shown to protect against I/R injury in normal and steatotic mouse livers. Therefore, the hepatoprotective properties of atorvastatin were evaluated in a rat model of cholestatic I/R injury.

METHODS:

Male Wistar rats were subjected to 70% hepatic ischemia (during 30 min) at 7 days after bile duct ligation. Rats were randomized to atorvastatin treatment or vehicle-control in three test arms: (1) oral treatment with 5 mg/kg during 7 days after bile duct ligation; (2) intravenous treatment with 2.5, 5, or 7.5 mg/kg at 24 h before ischemia; and (3) intravenous treatment with 5 mg/kg at 30 min before ischemia. Hepatocellular damage was assessed by plasma alanine aminotransferase (ALT) and histological necrosis.

RESULTS:

I/R induced severe hepatocellular injury in the cholestatic rat livers (~10-fold increase in ALT at 6 h after I/R and ~30% necrotic areas at 24 h after I/R). Both oral and intravenous atorvastatin treatment decreased ALT levels before ischemia. Intravenous atorvastatin treatment at 5 mg/kg at 24 h before ischemia was the only regimen that reduced ALT levels at 6 h after reperfusion, but not at 24 h after reperfusion. None of the tested regimens were able to reduce histological necrosis at 24 h after reperfusion.

CONCLUSION:

Pre-treatment with atorvastatin did not protect cholestatic livers from hepatocellular damage after I/R. Clinical studies investigating the role of statins in the protection against hepatic I/R injury should not include cholestatic patients with perihilar cholangiocarcinoma. These patients require (pharmacological) interventions that specifically target the cholestasis-associated hepatopathology.

PMID:
28399849
PMCID:
PMC5387220
DOI:
10.1186/s12893-017-0235-9
[Indexed for MEDLINE]
Free PMC Article
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10.
Cardiovasc Intervent Radiol. 2017 Jul;40(7):1118-1122. doi: 10.1007/s00270-017-1596-2. Epub 2017 Feb 7.

Resolution of Metallic Biliary Stent Allergic Reaction After Partial Stent Removal in a Patient with Nickel Sensitivity.

Author information

1
Division of Vascular and Interventional Radiology, Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, WCC-308F, Rosenberg Building, 1 Deaconess Road, Boston, MA, 02215, USA. aesparaz@bidmc.harvard.edu.
2
Department of Radiology, Beth Israel Deaconess Medical Center, WCC 308-B, 1 Deaconess Road, Boston, MA, 02215, USA. aesparaz@bidmc.harvard.edu.
3
Division of Vascular and Interventional Radiology, Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, WCC-308F, Rosenberg Building, 1 Deaconess Road, Boston, MA, 02215, USA.

Abstract

Local and systemic reactions to implanted metallic devices, particularly to those containing nickel, are well documented. Metal ions are released due to exposure of the metal to blood, proteins, other body fluids, and sheer mechanical stress. Metal ions then complex with native proteins and become antigens, which can elicit hypersensitivity reactions. Another case report depicts a specific allergic complication (early stent occlusion) related to metallic biliary stent implantation. We present a case of allergic symptoms, associated with eating, in a patient who developed nickel sensitivity after biliary metal stent placement confirmed by allergic skin testing to the same metallic biliary stent placed one year earlier. Symptoms resolved following partial removal of the non-epithelialized portion of the biliary stent.

KEYWORDS:

Allergic reaction; Allergy; Biliary stent; Hypersensitivity; Metallic; Nickel

PMID:
28175974
DOI:
10.1007/s00270-017-1596-2
[Indexed for MEDLINE]
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11.
Asian J Endosc Surg. 2017 Aug;10(3):295-300. doi: 10.1111/ases.12358. Epub 2017 Jan 30.

Comparison of laparoscopic hepaticojejunostomy and open hepaticojejunostomy. Can stenosis of the hilar hepatic duct affect postoperative outcome?

Author information

1
Department of Pediatric Surgery, Shizuoka Children's Hospital, Shizuoka, Japan.

Abstract

INTRODUCTION:

The aim of this study was to compare laparoscopic hepaticojejunostomy (LHJ) and open hepaticojejunostomy (OHJ) for choledochal cyst associated with hilar hepatic duct stenosis (HHDS).

METHODS:

Data collection was prospective for LHJ cases from 2009 and retrospective for OHJ cases from 2003 to 2008. Data were compared with respect to HHDS. HHDS was incised longitudinally as required during hilar hepatic ductoplasty.

RESULTS:

Fifty-eight subjects were studied (LHJ: n = 27, 4 boys, 23 girls; OHJ: n = 31; 6 boys, 25 girls). HHDS was present in 10 LHJ cases and 10 OHJ cases. Todani classification of choledochal cyst in LHJ patients was type 1A (n = 16) and type 4A (n = 11), and in OHJ patients, it was type 1A (n = 19) and type 4A (n = 12). There were significant differences between LHJ and OHJ with regard to mean operative time (386 vs 341 min), mean blood loss (5.9 vs 18.4 mL), recommencement of enteral feeding (3.9 vs 6.4 days), and hospital stay (11.7 vs 15.5 days) (all P < 0.05). Hepatic ductoplasty was performed in 23 LHJ patients and in 21 OHJ patients. There were no intraoperative complications and no conversions to OHJ. There were no significant differences between LHJ and OHJ, regardless of the presence of HHDS, for postoperative complications, which included minor bile leakage, anastomotic stricture, and intestinal obstruction.

CONCLUSION:

LHJ is as effective as OHJ for the treatment of choledochal cysts irrespective of the presence of HHDS and the need for hepatic ductoplasty.

KEYWORDS:

Bile duct stenosis; choledochal cyst; laparoscopic hepaticojejunostomy

PMID:
28134491
DOI:
10.1111/ases.12358
[Indexed for MEDLINE]
Icon for Wiley
12.
Clin Gastroenterol Hepatol. 2017 Jun;15(6):913-919.e1. doi: 10.1016/j.cgh.2016.12.013. Epub 2016 Dec 23.

Mutation Profile and Fluorescence In Situ Hybridization Analyses Increase Detection of Malignancies in Biliary Strictures.

Author information

1
Division of Digestive and Liver Disease, Department of Medicine, Columbia University Medical Center, New York, New York. Electronic address: tg2214@cumc.columbia.edu.
2
Division of Digestive and Liver Disease, Department of Medicine, Columbia University Medical Center, New York, New York.
3
Interpace Diagnostics Corporation, Pittsburgh, Pennsylvania.

Abstract

BACKGROUND & AIMS:

It is a challenge to detect malignancies in biliary strictures. Various sampling methods are available to increase diagnostic yield, but these require additional procedure time and expertise. We evaluated the combined accuracy of fluorescence in situ hybridization (FISH) and polymerase chain reaction-based DNA mutation profiling (MP) of specimens collected using standard brush techniques.

METHODS:

We performed a prospective study of 107 consecutive patients treated for biliary strictures by endoscopic retrograde cholangiopancreatography from June 2012 through June 2014. We performed routine cytology and FISH analyses on cells collected by standard brush techniques, and analyzed supernatants for point mutations in KRAS and loss-of-heterozygosity mutations in tumor-suppressor genes at 10 loci (MP analysis was performed at Interpace Diagnostics). Strictures were determined to be nonmalignant based on repeat image analysis or laboratory test results 12 months after the procedure. Malignant strictures were identified based on subsequent biopsy or cytology analyses, pathology analyses of samples collected during surgery, or death from biliary malignancy. We determined the sensitivity and specificity with which FISH and MP analyses detected malignancies using the exact binomial test.

RESULTS:

Our final analysis included 100 patients; 41% had biliary malignancies. Cytology analysis identified patients with malignancies with 32% sensitivity and 100% specificity. Addition of FISH or MP results to cytology results increased the sensitivity of detection to 51% (P < .01) without reducing specificity. The combination of cytology, MP, and FISH analyses detected malignancies with 73% sensitivity (P < .001). FISH identified an additional 9 of the 28 malignancies not detected by cytology analysis, and MP identified an additional 8 malignancies. FISH and MP together identified 17 of the 28 malignancies not detected by cytology analysis.

CONCLUSIONS:

Addition of FISH and mutation analyses to cytology analysis significantly increased the level of sensitivity with which we detected malignancy in biliary strictures, with 100% specificity. These techniques can be performed using standard brush samples collected during endoscopic retrograde cholangiopancreatography, with mutations detected in free DNA in supernatant fluid of samples. The tests are complementary and therefore should be used sequentially in the diagnostic evaluation of biliary strictures.

KEYWORDS:

Cancer Detection; Diagnosis; ERCP; Mutation Profile

PMID:
28017843
DOI:
10.1016/j.cgh.2016.12.013
[Indexed for MEDLINE]
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13.
Pan Afr Med J. 2016 Jun 29;24:174. eCollection 2016.

[Role of biliary MRI in etiological diagnosis of cholestatic icteruses in Dakar].

[Article in French]

Author information

1
Service de Radiologie Générale du CHU Aristide Le Dantec, Dakar, Sénégal.

Abstract

Biliary MRI is a relatively new diagnostic test in the arsenal of exploration techniques in biliopancreatic pathology. This is a reproducible and reliable non invasive technique for direct visualization of biliary and pancreatic ducts. This study aims to evaluate the morphological features of major abnormalities and the role of biliary MRI in the etiological diagnosis of cholestatic icteruses. This is a retrospective study of 17 patients conducted in the Imaging Unit of the University Hospital of Fann and of the Principal hospital of Dakar over a period of 4 years and six months (January 2008 at July 2012). All patients underwent MRI (1.5T) according to the standardized protocols for the explored pathology. Only medical records of patients whose diagnosis was established based on laboratory tests and who underwent biliary MRI and surgical exploration were retained. The study involved 5 women and 12 men with a sex ratio of 2.4. The average age of patients was 58 years, ranging between 35 and 81 years. Klatskin tumors were found in 7 patients with infiltrative form in 71% of cases and exophytic form was found in 28% of cases. Cancers of the gallbladder were found in 28% of cases. Cancers in the head of the pancreas accounted for 28% of cases. Major bile duct lithiasis was detected in 5 patients, choledocholithiasis in 60% of cases and a single lithiasis in 40% of cases. All these lesions were responsible for an expansion of intrahepatic bile duct (IHBD). One case of intra and extrahepatic bile ducts dilatation was found without biliopancreatic cause. Biliary MRI is the test of choice for the exploration of cholestatic icteruses. It should be recommended as first-line examination when residual lithiasis is suspected and as second-line examination after ultrasound, when the latter shows a suspected bile ducts tumoral obstruction. Its association with CT scan is the best combination of screening tests for etiologic diagnosis and pre-operative assessment of tumoral biliary obstructions.

KEYWORDS:

Bili- MRI; cholestatic jaundice; etiologies

PMID:
27795771
PMCID:
PMC5072859
DOI:
10.11604/pamj.2016.24.174.9894
[Indexed for MEDLINE]
Free PMC Article
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14.
J Dig Dis. 2016 Aug;17(8):501-509. doi: 10.1111/1751-2980.12378.

Role of farnesoid X receptor in cholestasis.

Author information

1
Department of Biliary-Pancreatic Surgery, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China.
2
Department of Biliary-Pancreatic Surgery, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China. keweipig@126.com.

Abstract

The nuclear receptor farnesoid X receptor (FXR) plays an important role in physiological bile acid synthesis, secretion and transport. Defects of FXR regulation in these processes can cause cholestasis and subsequent pathological changes. FXR regulates the synthesis and uptake of bile acid via enzymes. It also increases bile acid solubility and elimination by promoting conjugation reactions and exports pump expression in cholestasis. The changes in bile acid transporters are involved in cholestasis, which can result from the mutations of transporter genes or acquired dysfunction of transport systems, such as inflammation-induced intrahepatic cholestasis. The modulation function of FXR in extrahepatic cholestasis is not identical to that in intrahepatic cholestasis, but the discrepancy may be reduced over time. In extrahepatic cholestasis, increasing biliary pressure can induce bile duct proliferation and bile infarcts, but the absence of FXR may ameliorate them. This review provides an update on the function of FXR in the regulation of bile acid metabolism, its role in the pathophysiological process of cholestasis and the therapeutic use of FXR agonists.

KEYWORDS:

bile acid; cholestasis; enterohepatic circulation; farnesoid X receptor; hepatobiliary transport

PMID:
27383832
DOI:
10.1111/1751-2980.12378
[Indexed for MEDLINE]
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15.
Eur J Gastroenterol Hepatol. 2017 Feb;29(2):231-237. doi: 10.1097/MEG.0000000000000762.

Higher quality of life after metal stent placement compared with plastic stent placement for malignant extrahepatic bile duct obstruction: a randomized controlled trial.

Author information

1
aDepartment of Gastroenterology and Hepatology bJulius Center for Health Sciences and Primary Care, University Medical Center cDepartment of Gastroenterology and Hepatology, Diakonessen Hospital, Utrecht dDepartment of Gastroenterology and Hepatology, Rijnstate Hospital, Arnhem eDepartment of Gastroenterology and Hepatology, St Antonius Hospital, Nieuwegein fDepartment of Gastroenterology and Hepatology, Gelderse Vallei Hospital, Ede gDepartment of Gastroenterology and Hepatology, Zorg Groep Twente, Hengelo hDepartment of Gastroenterology and Hepatology, Meander Medical Center, Amersfoort iDepartment of Gastroenterology and Hepatology, Haga Hospital, Den Haag jDepartment of Gastroenterology and Hepatology, Canisius Wilhelmina Hospital, Nijmegen kDepartment of Gastroenterology and Hepatology, Albert Schweitzer Hospital, Dordrecht lDepartment of Gastroenterology and Hepatology, Medisch Spectrum Twente, Enschede mDepartment of Gastroenterology and Hepatology, Onze Lieve Vrouwe Gasthuis, Amsterdam nDepartment of Gastroenterology and Hepatology, Amphia Hospital, Breda oDepartment of Gastroenterology and Hepatology, VieCuri Hospital, Venlods pDepartment of Gastroenterology and Hepatology, Martini Hospital qDepartment of Gastroenterology and Hepatology, University Medical Center Groningen, Groningen rDepartment of Gastroenterology and Hepatology, Jeroen Bosch Hospital, Den Bosch sDepartment of Decision Analysis, Erasmus University Medical Center, Rotterdam, The Netherlands tDepartment of Gastroenterology and Hepatology, University Hospital Gasthuisberg, University of Leuven, Leuven, Belgium.

Abstract

OBJECTIVE:

For palliation of extrahepatic bile duct obstruction, self-expandable metal stents (SEMS) are superior to plastic stents in terms of stent patency and occurrence of stent dysfunction. We assessed health-related quality of life (HRQoL) after stent placement to investigate whether this also results in a difference in HRQoL between patients treated with a plastic stent or SEMS.

PATIENTS AND METHODS:

This randomized multicenter trial included 219 patients who were randomized to receive plastic stent (n=73) or SEMS [uncovered (n=75) and covered (n=71); n=146] placement. HRQoL was assessed with two general questionnaires (EQ-5D-3L and QLQ-C30) and one disease-specific questionnaire (PAN-26). Scores were analyzed using linear mixed model regression and included all patients with baseline and at least one follow-up measurement.

RESULTS:

HRQoL data were available in 140 of 219 patients (64%); 71 patients (32%) declined participation and in eight patients (4%) only baseline questionnaires were available. On the QLQ-C30, the interaction between follow-up time and type of stent was significantly different on two of five functional scales [physical functioning (P=0.004) and emotional functioning (P=0.01)] in favor of patients with a SEMS. In addition, patients with SEMS reported significantly less frequent symptoms of fatigue (P=0.01), loss of appetite (P=0.02), and nausea and vomiting (0.04) over time. The EQ-VAS score decreased with time in both treatment groups, indicating a statistically significant decrease in HRQoL over time.

CONCLUSION:

In patients with inoperable malignant extrahepatic bile duct obstruction, SEMS placement results in better scores for general and disease-specific HRQoL over time compared with plastic stent placement.

PMID:
27741030
DOI:
10.1097/MEG.0000000000000762
[Indexed for MEDLINE]
Icon for Wolters Kluwer
16.
J Surg Res. 2016 Oct;205(2):359-367. doi: 10.1016/j.jss.2016.06.094. Epub 2016 Jul 5.

Effects of Myrtus communis extract treatment in bile duct ligated rats.

Author information

1
Department of Pharmacognosy, School of Pharmacy, Marmara University, İstanbul, Turkey.
2
Department of Internal Medicine, Haydarpasa Numune Training and Research Hospital, İstanbul, Turkey.
3
Department of Pharmacology, School of Pharmacy, Marmara University, İstanbul, Turkey.
4
Department of Biochemistry, School of Pharmacy, Cumhuriyet University, Sivas, Turkey.
5
Department of Histology & Embryology, School of Medicine, Marmara University, İstanbul, Turkey.
6
Department of Pharmacology, School of Pharmacy, Marmara University, İstanbul, Turkey. Electronic address: gsener@marmara.edu.tr.

Abstract

BACKGROUND:

The aim of our study was to investigate the antifibrotic and antioxidant effects of Myrtus communis subsp. communis (MC) extract against liver injury and fibrosis occurring in rats with biliary obstruction.

MATERIALS AND METHODS:

The rats were randomized into four groups (n = 8). Control group (C), MC-administrated group (MC), the bile duct ligation (BDL), and BDL + MC groups. MC was administered at a dose of 50 mg/kg a day orally for 28 days. In blood samples, total bilirubin, direct bilirubin, alanine aminotransferase, aspartate aminotransferase levels, tumor necrosis factor-α, and interleukin-1β measurement were measured. Oxidative injury was examined by measuring luminol and lucigenin chemiluminescence, malondialdehyde and glutathione levels, superoxide dismutase and myeloperoxidase activities. Transforming growth factor-beta and hydroxyproline levels were measured for analyzing fibrosis. The hepatic injury was also analyzed microscopically.

RESULTS:

Plasma total bilirubin, direct bilirubin, alanine aminotransferase, aspartate aminotransferase, tumor necrosis factor-α, and interleukin-1β levels were found significantly high in the BDL group, while these values significantly decreased in the BDL group treated with MC. On the other hand, the glutathione and superoxide dismutase values significantly decreased in the BDL group compared to the control group but increased markedly in BDL + MC group compared to the BDL group. Malondialdehyde levels, myeloperoxidase activity, tissue luminol, lucigenin, transforming growth factor-beta, and hydroxyproline levels when compared with the control group increased dramatically in the BDL group and reduced the MC + BDL group.

CONCLUSIONS:

Our results suggest that MC protects the liver tissues against oxidative damage following BDL via its radical scavenging and antioxidant activities, which appear to involve the inhibition of tissue neutrophil infiltration.

KEYWORDS:

Bile ductal ligation; Hepatic fibrosis; Myrtus communis subsp. communis; Oxidative injury

PMID:
27664884
DOI:
10.1016/j.jss.2016.06.094
[Indexed for MEDLINE]
Icon for Elsevier Science
17.
Gastrointest Endosc. 2017 Feb;85(2):357-364. doi: 10.1016/j.gie.2016.07.067. Epub 2016 Aug 24.

Percutaneous transhepatic versus EUS-guided gallbladder drainage for malignant cystic duct obstruction.

Author information

1
Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Korea.
2
Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam-si, Korea.
3
Department of Internal Medicine, Eulgi University College of Medicine, Daejun Eulji University Hospital, Daejeon, Korea.
4
Department of Radiology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam-si, Korea.

Abstract

BACKGROUND AND AIMS:

Endoscopic ultrasound-guided gallbladder drainage (EUS-GBD) has been proposed as an alternative management strategy for acute cholecystitis caused by malignant cystic duct obstruction in patients for whom surgery is not an option. This study aimed to compare the results of EUS-GBD with those of percutaneous transhepatic gallbladder drainage (PTGBD) for palliative management of malignant cystic duct obstruction with acute cholecystitis or symptomatic gallbladder hydrops.

METHODS:

Between November 2013 and November 2015, 14 patients with acute cholecystitis or symptomatic gallbladder hydrops as a result of malignant cystic duct obstruction underwent EUS-GBD with covered metal stents. Nineteen patients with acute cholecystitis as a result of malignant cystic duct obstruction who received PTGBD served as a control group. Patients' medical records were reviewed retrospectively.

RESULTS:

The technical and clinical success rates of EUS-GBD were 85.7% (12/14) and 91.7% (11/12) and of PTGBD were 100% (19/19) and 86.4% (17/19), respectively. The groups had similar adverse event rates (28.5% and 21.1%, respectively). The average duration of stent patency in patients with EUS-GBD was 130.3 ± 35.3 days, and no patient required an additional procedure before death. In 6 of 17 patients (35.3%) with clinically successful PTGBD, the catheter was not removed until the end stage of life.

CONCLUSIONS:

EUS-GBD is a feasible, safe, and effective modality for the treatment of malignant cystic duct obstruction in patients who are not indicated for surgery. It enables improved long-term quality of life in patients with advanced-stage cancer.

PMID:
27566055
DOI:
10.1016/j.gie.2016.07.067
[Indexed for MEDLINE]
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18.
Dig Endosc. 2017 Jan;29(1):118-121. doi: 10.1111/den.12709. Epub 2016 Sep 22.

Endoscopic biodegradable biliary stents in the treatment of benign biliary strictures: First report of clinical use in patients.

Author information

1
Department of Gastroenterology and Alimentary Tract Surgery, Tampere University Hospital, Tampere, Finland.
2
Department of Clinical Radiology, Tampere University Hospital, Tampere, Finland.
3
Päijät-Häme Central Hospital, Lahti, Finland.

Abstract

The first clinical experience of endoscopically inserted polydioxanone biodegradable biliary stents (BDBS) in the treatment of benign biliary strictures is reported. Two patients with a benign common bile duct stricture were endoscopically treated with 8-mm-bore BDBS during endoscopic retrograde cholangiography. Both BDBS insertions were technically successful and without adverse events. At 6 months, the stricture resolution was excellent and BDBS degradation was predicted in repeated magnetic resonance imaging. The first experience with endoscopic BDBS seems promising in the treatment of benign biliary strictures. During 6 months of follow up, BDBS seemed sufficient for remodeling and resolution of strictures. Further studies are needed to confirm the effectiveness of biodegradable biliary stents in endoscopic management of benign biliary strictures.

KEYWORDS:

Biliary stent; ERCP; bioabsorbable; biodegradable

PMID:
27514703
DOI:
10.1111/den.12709
[Indexed for MEDLINE]
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19.
Dig Endosc. 2017 Jan;29(1):97-103. doi: 10.1111/den.12700. Epub 2016 Sep 19.

Metal versus plastic stents for unresectable gallbladder cancer with hilar duct obstruction.

Author information

1
Department of Endoscopy, Eastern Hepatobiliary Hospital, The Second Military Medical University, Shanghai, China.

Abstract

BACKGROUND AND AIM:

Metal stents usually have a longer stent patency than plastic stents for malignant biliary obstruction. However, stent patency and patient survival may differ depending on the causative disease and stent type. There are no data regarding the selection of stents for unresectable gallbladder cancer (GC) with hilar duct obstruction. The aim of the present study was to evaluate the efficacy of metal versus plastic stents for unresectable GC with hilar duct obstruction.

METHODS:

Fifty-nine unresectable GC patients with jaundice were divided into metal stent group (MSG) and plastic stent group (PSG) depending on stent deployment. Clinical outcomes and approximate costs were assessed retrospectively.

RESULTS:

No significant difference was found between MSG (n = 28) and PSG (n = 31) for clinical success, early adverse events and later cholangitis. Median patency and survival were 119 and 112 days in MSG versus 93 and 118 days in PSG, respectively (P > 0.05). However, the overall cost was higher in MSG than in PSG (P = 0.00). Cox proportional hazards model analysis showed that the lower Bismuth type was associated with a longer stent patency (P = 0.046), whereas older age (P = 0.041) and lower TNM stage (P = 0.002) were associated with longer survival.

CONCLUSION:

Although metal and plastic stents have similar clinical efficacy, it seems reasonable to choose plastic stents as the treatment of choice for unresectable GC when cost-effectiveness is taken into account.

KEYWORDS:

endoscopic retrograde cholangiopancreatography (ERCP); gallbladder cancer; malignant biliary obstruction; plastic stent; self-expandable metal stent

PMID:
27431375
DOI:
10.1111/den.12700
[Indexed for MEDLINE]
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20.
J Surg Res. 2016 Jun 15;203(2):275-82. doi: 10.1016/j.jss.2016.03.002. Epub 2016 Mar 25.

Differentiation of benign and malignant hilar bile duct stenosis.

Author information

1
Department of Hepatobiliary Surgery, China-Japan Friendship Hospital, Beijing, China.
2
Department of Hepatobiliary Surgery, China-Japan Friendship Hospital, Beijing, China. Electronic address: yangzhy@aliyun.com.
3
Department of Pathology, China-Japan Friendship Hospital, Beijing, China.

Abstract

BACKGROUND:

Failure to differentiate benign and malignant hilar bile duct stenosis may lead to inappropriate treatment. We retrospectively analyzed the methods for differentiation.

MATERIALS AND METHODS:

A total of 53 patients with hilar bile duct stenosis were included, comprising 41 malignant cases (hilar cholangiocarcinoma) and 12 benign cases (six primary sclerosing cholangitis and six IgG4-associated sclerosing cholangitis). Data of clinical histories, laboratory tests, imaging studies, and liver pathologies were collected, and comparison was made between benign and malignant groups.

RESULTS:

Compared with malignant group, patients in the benign group were more likely to have multiorgan involvement of clinical histories (P < 0.001). There was no difference on bilirubin, liver enzyme, and serum tumor marker between the two groups, whereas serum IgG4 levels were higher in the benign group (P = 0.003). Patients in the benign group were more likely to have pancreatic changes (P < 0.001) and multiple-segmental bile duct stenosis (P < 0.001) on imaging. Compared with the malignant group, patients in the benign group were more likely to show severe periportal inflammation in noninvolved liver (P < 0.001), fibrosis around intrahepatic bile duct (P < 0.001), and more IgG4-positive plasma cells (P < 0.001) on liver pathology.

CONCLUSIONS:

Benign lesion should be considered for patients with history of multiorgan involvement, pancreas changes, or multiple-segmental bile duct stenosis on imaging. Liver biopsy could be helpful for differential diagnosis before surgery.

KEYWORDS:

Benign; Biliary stenosis; Hilar cholangiocarcinoma; Sclerosing cholangitis

PMID:
27363632
DOI:
10.1016/j.jss.2016.03.002
[Indexed for MEDLINE]
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