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Malignant biliary

Alexandra G Lopez-Aguiar, Cecilia G Ethun, Timothy M Pawlik, Thuy Tran, George A Poultsides, Chelsea A Isom, Kamran Idrees, Bradley A Krasnick, Ryan C Fields, Ahmed Salem, Sharon M Weber, Robert C G Martin, Charles R Scoggins, Perry Shen, Harveshp D Mogal, Eliza W Beal, Carl Schmidt, Rivfka Shenoy, Ioannis Hatzaras, Shishir K Maithel
BACKGROUND: Perioperative allogeneic blood transfusion is associated with poor oncologic outcomes in multiple malignancies. The effect of blood transfusion on recurrence and survival in distal cholangiocarcinoma (DCC) is not known. METHODS: All patients with DCC who underwent curative-intent pancreaticoduodenectomy at 10 institutions from 2000 to 2015 were included. Primary outcomes were recurrence-free (RFS) and overall survival (OS). RESULTS: Among 314 patients with DCC, 191 (61%) underwent curative-intent pancreaticoduodenectomy...
March 15, 2019: Annals of Surgical Oncology
Fumisato Kozakai, Yoshihide Kanno, Kei Ito, Shinsuke Koshita, Takahisa Ogawa, Hiroaki Kusunose, Kaori Masu, Toshitaka Sakai, Toji Murabayashi, Keisuke Yonamine, Yujiro Kawakami, Yuki Fujii, Kazuaki Miyamoto, Yutaka Noda
Background/Aims: : It is often difficult to manage acute cholecystitis after metal stent (MS) placement in unresectable malignant biliary strictures. The aim of this study was to evaluate the feasibility of endoscopic ultrasonography-guided gallbladder drainage (EUS-GBD) for acute cholecystitis. Methods: : The clinical outcomes of 10 patients who underwent EUS-GBD for acute cholecystitis after MS placement between January 2011 and August 2018 were retrospectively evaluated...
March 15, 2019: Clinical Endoscopy
Jon Arne Søreide, Lars Normann Karlsen, Gabriel Sandblom, Lars Enochsson
BACKGROUND: Endoscopic retrograde cholangiopancreatography (ERCP) was introduced more than four decades ago as a diagnostic tool for biliary and pancreatic diseases. Currently, ERCP is mainly used as a therapeutic approach to relieve biliary or pancreatic duct obstruction. Clinical practice has been based on a few large reports and some randomized controlled trials. These data are valuable and important, but the external validity of these reports is limited. Implementation into routine practice should be balanced with the knowledge that these studies were conducted under very specific circumstances...
March 12, 2019: Surgical Endoscopy
Lorenza Rimassa, Nicola Personeni, Alessio Aghemo, Ana Lleo
Cholangiocarcinoma (CCA) is a deadly cancer of the biliary epithelium with limited therapeutic options. It is a heterogeneous group of cancer that could develop at any level from the biliary tree and is currently classified into intrahepatic, perihilar and distal based on its anatomical location. With incidence and mortality rates currently increasing, it is now the second most common type of primary liver cancer and represents up to 3% of all gastrointestinal malignancies. High-throughput genomics and epigenomics have greatly increased our understanding of CCA underlying biology, however its pathogenesis remains largely unknown...
March 9, 2019: Journal of Autoimmunity
Yun Nah Lee, Seok Jeong, Hyun Jong Choi, Jae Hee Cho, Young Koog Cheon, Se Woo Park, Yeon Suk Kim, Don Haeng Lee, Jong Ho Moon
BACKGROUND AND AIMS: Catheter-based endobiliary radiofrequency ablation (RFA) is an endoscopic local treatment for patients with malignant biliary stricture (MBS). However, excessive heating of the bile duct by the current RFA system can induce serious complications. Recently, a new RFA system with automatic temperature control was developed. In the present study, we examined the safety of the new RFA system in patients undergoing endobiliary RFA for extrahepatic MBS. METHODS: This prospective, multicenter study enrolled patients with unresectable or inoperable extrahepatic (>2 cm from the hilum) MBS...
March 12, 2019: Journal of Gastroenterology and Hepatology
Anna Saborowski, Katharina Wolff, Steffi Spielberg, Benedikt Beer, Björn Hartleben, Zulrahman Erlangga, Diana Becker, Lukas E Dow, Silke Marhenke, Norman Woller, Kristian Unger, Peter Schirmacher, Michael P Manns, Jens U Marquardt, Arndt Vogel, Michael Saborowski
The rising incidence of cholangiocarcinoma (CCA) coupled with a low 5-year survival rate that remains below 10% delineates the urgent need for more effective treatment strategies. Although several recent studies provided detailed information on the genetic landscape of this fatal malignancy, versatile model systems to functionally dissect the immediate clinical relevance of the identified genetic alterations are still missing. To enhance our understanding of CCA pathophysiology and facilitate rapid functional annotation of putative CCA driver and tumor maintenance genes, we developed a tractable murine CCA model by combining the cyclization recombination (Cre)-lox system, RNA interference, and clustered regularly interspaced short palindromic repeats/CRISPR associated protein 9 (CRISPR/Cas9) technology with liver organoids, followed by subsequent transplantation into immunocompetent, syngeneic mice...
March 2019: Hepatology Communications
Michael S Torbenson, Christina A Arnold, Rondell P Graham, Dhanpat Jain, Sanjay Kakar, Dora M Lam-Himlin, Bita V Naini, Tsung-Teh Wu, Matthew Yeh
Extramural consultation for challenging pathology cases is an important part of patient care. The specific reasons why liver cases are submitted in consultation are poorly understood. To study patterns in extramural consultation, data were gathered from 1360 liver/GI/pancreatobiliary consults submitted to 7 academic centers. Liver cases comprised 40% of consults and are the focus of this paper. They were submitted for questions on medical (61%) and tumor pathology (39%). A preliminary diagnosis was provided by the referring pathologist in 65% of cases...
March 8, 2019: Human Pathology
Eui Joo Kim, Jae Hee Cho
No abstract text is available yet for this article.
March 12, 2019: Clinical Endoscopy
Xiahong Hu, Zhaoxia Tan, Yijiang Yang, Pinghui Yang
INTRODUCTION: Cholangiocarcinoma (CCA), one of the most common primary biliary malignant tumors with high mortality. MIR22HG has been reported to act as a tumor-suppressor gene in several types of cancers. But, the role and molecular regulatory mechanism of MIR22HG in CCA are still unclear. AIM: The aim of the present study is to investigate the role and the underlying mechanism of MIR22HG in CCA. RESULTS: In this study, we firstly found that MIR22HG expression was significantly downregulated in CCA tissues and cell lines...
March 11, 2019: Journal of Gene Medicine
S S Shestopalov, S A Mikhailova, E I Abramov, E V Ozhigina
AIM: To determine optimal time of biliary tract decompression and bile reinfusion into gastrointestinal tract in patients with malignant obstructive jaundice. MATERIAL AND METHODS: 179 medical records of patients with obstructive jaundice were analyzed in order to identify risk factors of postoperative complications. Prospective trial included bile examination in 34 patients with malignant obstructive jaundice. The new algorithm of preoperative preparation of patients was proposed using these data...
2019: Khirurgiia
Yang Liu, Chao Cheng, Lan Bai, Feng Yao, Shenchao Shi, Yu Zhang
AIMS: Increasing evidence has demonstrated that serum soluble B7H3(sB7-H3) is a useful tumor marker for cancer diagnosis and prognostic evaluations. Whether sB7-H3 expressed in the bile is related to the progression of malignant biliary strictures must be clarified. METHODS: Bile sB7-H3 was obtained via endoscopic retrograde cholangiopancreatography (ERCP) from 323 patients suspected to have malignant biliary strictures and was detected using a B7H3 ELISA kit. Diagnostic value was compared among bile sB7-H3, CA19-9, CA12-5, and CEA and ERCP-based cytological/tissue examination...
March 2019: Surgical Oncology
Carlo Fabbri, Alessandro Fugazza, Cecilia Binda, Alessandro Zerbi, Elio Jovine, Vincenzo Cennamo, Alessandro Repici, Andrea Anderloni
We present five cases of pylorus-preserving pancreaticoduodenectomy (PPPD) after endoscopic ultrasonography-guided choledochoduodenostomy (EUS-CD) using a lumen-apposing metal stent (LAMS) as a bridge to surgery in patients with resectable distal malignant biliary obstruction and failed endoscopic retrograde cholangiopancreatography (ERCP). The patients underwent an EUS-CD using EC-LAMS, the bile duct being accessed using the transbulbar approach. The technical success rate of EUS-CD was 100%. No procedure-related adverse events occurred...
March 2019: Journal of Gastrointestinal and Liver Diseases: JGLD
Samuele Iesari, Milton Eduardo Inostroza Núñez, Juan Manuel Rico Juri, Olga Ciccarelli, Eliano Bonaccorsi-Riani, Laurent Coubeau, Pierre-François Laterre, Pierre Goffette, Chantal De Reyck, Benoît Lengelé, Pierre Gianello, Jan Lerut
BACKGROUND: Liver transplantation is the treatment for end-stage liver diseases and well-selected malignancies. The allograft shortage may be alleviated with living donation. The initial UCLouvain experience of adult living-donor liver transplantation (LDLT) is presented. METHODS: A retrospective analysis of 64 adult-to-adult LDLTs performed at our institution between 1998 and 2016 was conducted. The median age of 29 (45.3%) females and 35 (54.7%) males was 50.2 years (interquartile range, IQR 32...
February 28, 2019: Hepatobiliary & Pancreatic Diseases International: HBPD INT
Karl Vaz, Raphael P Luber, Catriona McLean, Jan Frank Gerstenmaier, Stuart K Roberts
INTRODUCTION: Gastric adenocarcinoma is a known complication of partial gastrectomy. Jaundice from gastric adenocarcinoma usually occurs in the setting of hepatic nodal or parenchymal metastasis. This case demonstrates an unusual level of biliary obstruction from gastric adenocarcinoma. CASE PRESENTATION: An 84-year-old Caucasian man was diagnosed as having a new gastric adenocarcinoma at the level of the gastroenteric anastomosis of a prior Billroth II gastrectomy after presenting with painless jaundice...
March 9, 2019: Journal of Medical Case Reports
Ross C D Buerlein, Andrew Y Wang
Most patients with perihilar cholangiocarcinoma present with surgically unresectable disease owing to the insidious nature of this malignancy. Relief of malignant perihilar biliary obstruction is a key aspect of cholangiocarcinoma. Although palliative stenting using uncovered metal stents has been advocated in patients with unresectable malignant perihilar biliary strictures, several endoscopic retrograde cholangiopancreatography-guided ablative modalities have emerged. Palliative photodynamic therapy, radiofrequency ablation, and intraluminal brachytherapy have been associated with improved stent patency and survival, although the ideal treatment approach remains unclear...
April 2019: Gastrointestinal Endoscopy Clinics of North America
Jeremy S Nussbaum, Nikhil A Kumta
Endoscopic retrograde cholangiopancreatography is the preferred procedure for biliary drainage in benign and malignant obstructions. Endoscopic ultrasound-guided biliary drainage is an emerging technique for when endoscopic retrograde cholangiopancreatography fails. It is a highly versatile procedure with several options of access point, stent direction, and drainage route. Based on the current literature, the cumulative success rate is 88% to 93%, with an overall complication rate of 13% to 20%. Endoscopic ultrasound-guided biliary drainage seems to be an effective and valuable alternative technique after failed endoscopic retrograde cholangiopancreatography when performed by highly skilled endoscopists...
April 2019: Gastrointestinal Endoscopy Clinics of North America
Jason G Bill, Daniel K Mullady
Benign and malignant biliary strictures are common indications for endoscopic retrograde cholangiopancreatography. Diagnosis involves high-quality cross-sectional imaging and cholangiography with various endoscopic sampling techniques. Treatment options include placement of plastic biliary stents and self-expanding metal stents, which differ in patency duration and cost effectiveness. Whether the etiology is benign or malignant, a multidisciplinary strategy should be implemented. This article will discuss general principles of biliary stenting in both benign and malignant conditions...
April 2019: Gastrointestinal Endoscopy Clinics of North America
Aleksey Novikov, Thomas E Kowalski, David E Loren
Indeterminate biliary strictures pose a diagnostic and therapeutic challenge. Although underlying malignancy is a primary concern, biliary strictures may result from benign processes. An accurate diagnosis is paramount to define the treatment strategy and minimize morbidity. The limitations of traditional endoscopic retrograde cholangiopancreatography-based tissue acquisition with cytology brushings are well-documented. Endoscopic retrograde cholangiopancreatography is generally unable to determine a stricture's etiology...
April 2019: Gastrointestinal Endoscopy Clinics of North America
Adeel S Khan, Leigh Anne Dageforde
Cholangiocarcinoma is a rare malignancy and accounts for 2% of all malignancies. Incidence is on the increase in the Western world. Cholangiocarcinoma arises from the malignant growth of the epithelial lining of the bile ducts and can be found all along the biliary tree. It can be classified into subtypes based on location: intrahepatic (arising from the intrahepatic biliary tract in the hepatic parenchyma), perihilar (at the hilum of the liver involving the biliary confluence) and distal (extrahepatic, often in the head of the pancreas)...
April 2019: Surgical Clinics of North America
Zaheer S Kanji, Flavio G Rocha
Although the most common presentation of biliary disorder in North America is secondary to gallstone disease, an awareness of benign biliary cystic neoplasms is important because of the risk of malignant transformation. The incidence of premalignant cystic neoplasms of the bile duct is not well characterized and they often are detected incidentally for suspicion of other abdominal disorders. This article describes the 4 most common premalignant biliary cystic neoplasms: biliary mucinous cystic neoplasms, intraductal papillary mucinous neoplasms of the bile duct, intraductal tubular papillary neoplasms of the bile duct, and choledochal cysts...
April 2019: Surgical Clinics of North America
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