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Occult pancreaticobiliary reflux is a pathogenic factor of some benign biliary diseases and gallbladder cancer

Hepatobiliary & Pancreatic diseases International 2023年第3期22卷 288-293页

作者： Lu Wang Zhi-Wei Zhang Tong Guo Peng Xie Xiao-Rui Huang Ya-Hong Yu Department of Organ Transplantation Tongji HospitalTongji Medical CollegeHuazhong University of Science and TechnologyKey Laboratory of Organ TransplantationMinistry of EducationNHC Key Laboratory of Organ TransplantationKey Laboratory of Organ TransplantationChinese Academy of Medical SciencesWuhan 430000China Department of Biliopancreatic Surgery Tongji HospitalTongji Medical CollegeHuazhong University of Science and TechnologyWuhan 430000China

Background:Pancreaticobiliary maljunction(PBM)is a well-known high-risk factor for biliary malignant tumors because of constant pancreaticobiliary reflux(PBR).However,the impact of occult pancreaticobiliary reflux(OPR),which is characterized by high bile amylase levels in individuals with anatomically normal pancreaticobiliary junction,on biliary diseases remains *** aim of this study was to assess the correlation between OPR and biliary ***:We enrolled 94 consecutive patients with normal pancreaticobiliary junction and primary biliary diseases confirmed by magnetic resonance *** prospectively collected patients’bile samples and measured bile amylase *** investigated the incidence of OPR and the difference in bile amylase levels among these patients and assessed the correlation between high bile amylase levels(HBAL)and benign or malignant biliary diseases,as well as the OPR risk ***:The incidence of OPR was 36.6%in patients with benign biliary diseases,26.7%in those with cholangiocarcinoma and 62.5%in those with gallbladder *** median bile amylase level tended to be higher in patients with gallbladder cancer than in those with benign biliary diseases,but there was no significant difference(165.5 IU/L vs.23.0 IU/L,P=0.212).The prevalence of an HBAL with bile amylase levels of 1000-7500 IU/L was similar in patients with gallbladder cancer and benign biliary ***,the incidence of HBAL with bile amylase levels greater than 7500 IU/L was significantly higher in patients with gallbladder cancer than in those with benign biliary diseases(37.5%vs.4.2%,P=0.012).Multivariate logistic regression analysis revealed that choledocholithiasis was an independent risk factor for ***:OPR can occur in benign and malignant biliary diseases,and it may be a pathogenic factor for some benign biliary diseases and a high-risk factor for gallbladder *** is a correlation between choledocholit

关键词： Occult pancreaticobiliary reflux biliary diseases Bile amylase Pancreaticobiliary junction Gallbladder cancer

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Western blotting in the diagnosis of duodenal-biliary and pancreaticobiliary refluxes in biliary diseases

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Hepatobiliary & Pancreatic diseases International 2009年第6期8卷 608-613页

作者： Chun-Chih Chen Department of General Surgery Shengjing HospitalChina Medical University

BACKGROUND: Currently adopted diagnostic methods for duodenal-biliary and pancreaticobiliary refluxes carry many flaws, so the incidence of the two refluxes demands further larger sample size studies. This study aimed to evaluate Western blotting for the diagnosis of refluxes in biliary diseases. METHODS: An oral radionuclide (99)mTc-DTPA test (radionuclide, RN) was conducted for the observation of duodenal-biliary reflux prior to measuring bile radioactivity and Western blotting for detecting bile enterokinase (EK). Pancreaticobiliary reflux was assessed by biochemical and Western blotting tests for biliary amylase activity and trypsin-1, respectively. In accordance with bile sample origin, our samples were classified into ductal bile and gall bile groups; based on each individual biliary disease, we further classified the ductal bile group into five subgroups, and the gall bile group into four sub-groups. Western blotting was conducted to assess the two refluxes in biliary diseases. RESULTS: Consistencies were noted between EK and RN tests when diagnosing duodenal-biliary reflux (Pbiliary reflux (P0.05); in the common bile duct cyst group, the EK positive rate was significantly lower than the trypsin-1 positive rate (Pbiliary and pancreaticobiliary refluxes. EK has greater sensitivity than RN for duodenal-biliary reflux. The majority of biliary amylase and lipase comes from the pancreas in all biliary diseases; pancreaticobiliary reflux is the predominant source in the common bile duct cyst group and duodenal-biliary reflux is responsible for the ductal pigment stone group.

关键词： pancreaticobiliary reflux duodenal-biliary reflux trypsin-1 enterokinase biliary diseases

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Therapeutic experience of 289 elderly patients with biliary diseases

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World Journal of Gastroenterology 2017年第13期23卷 2424-2434页

作者： Zong-Ming Zhang Zhuo Liu Li-Min Liu Chong Zhang Hong-Wei Yu Bai-Jiang Wan Hai Deng Ming-Wen Zhu Zi-Xu Liu Wen-Ping Wei Meng-Meng Song Yue Zhao Department of General Surgery Beijing Electric Power Hospital State Grid Corporation of China Capital Medical University

AIM To present clinical characteristics, diagnosis and treatment strategies in elderly patients with biliary diseases. METHODS A total of 289 elderly patients with biliary diseases were enrolled in this study. The clinical data relating to these patients were collected in our hospital from June 2013 to May 2016. Patient age, disease type, coexisting diseases, laboratory examinations, surgical methods, postoperative complications and therapeutic outcomes were analyzed. RESULTS The average age of the 289 patients with biliary diseases was 73.9 +/- 8.5 years (range, 60-102 years). One hundred and thirty-one patients (45.3%) had one of 10 different biliary diseases, such as gallbladder stones, common bile duct stones, and cholangiocarcinoma. The remaining patients (54.7%) had two types of biliary diseases. One hundred and seventy-nine patients underwent 9 different surgical treatments, including pancreaticoduodenectomy, radical resection of hilar cholangiocarcinoma and laparoscopic cholecystectomy. Ten postoperative complications occurred with an incidence of 39.3% (68/173), and hypopotassemia showed the highest incidence (33.8%, 23/68). One hundred and sixteen patients underwent non-surgical treatments, including anti-infection, symptomatic and supportive treatments. The cure rate was 97.1% (168/173) in the surgical group and 87.1% (101/116) in the non-surgical group. The difference between these two groups was statistically significant (chi(2) = 17.227, P diseases, management of indications and surgical opportunities, appropriate selection of surgical procedures, improvements in perioperative therapy, and timely management of postoperative complications are key factors in enhancing therapeutic efficacy in elderly patients with biliary diseases.

关键词： biliary diseases Elderly patients Surgical treatment Non-operative treatment

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Current considerations for the surgical management of gallbladder adenomas

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World Journal of Gastrointestinal Surgery 2024年第6期16卷 1507-1512页

作者： Efstathios T Pavlidis Ioannis N Galanis Theodoros E Pavlidis The Second Department of Propaedeutic Surgery Hippokration General HospitalSchool of MedicineAristotle University of ThessalonikiThessaloniki 54642Greece

Gallbladder adenomas are rare lesions(0.5%)associated with potential malignant transformation,particularly with gallbladder adenomas that are≥1 cm in *** detection and management are crucial for preventing lethal carcinoma *** polyps can often be distinguished from the more often nonneo-plastic cholesterol pseudopolyps(5%-10%),which are *** is the first-line tool for initial diagnosis and follow-up when *** question is whether cholecystectomy is always necessary for all *** manage-ment of gallbladder adenomas is determined according to the size of the tumor,the growth rate of the tumor,the patient’s symptoms and whether risk factors for malignancy are ***≥1 cm in size,an age>50 years and a familial history of gallbladder carcinoma are indications for immediate laparoscopic ***,ultrasound follow-up is *** adenomas 6-9 mm in size,the absence of≥2 mm growth at 6 months,one year,and two years,as well as an adenoma sized<5 mm without existing risk factors indicates that no further surveillance is ***,it would be preferable to individualize the management in doubtful *** interventional modalities for preserving the gallbladder need further evaluation,especially to determine the long-term outcomes.

关键词： biliary diseases True neoplastic polyps Gallbladder adenomas Benign bi-liary tumors Gallbladder polyps Extrahepatic biliary neoplasms

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Current management of concomitant cholelithiasis and common bile duct stones

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World Journal of Gastrointestinal Surgery 2023年第2期15卷 169-176页

作者： Efstathios T Pavlidis Theodoros E Pavlidis 2^(nd)Propedeutic Department of Surgery Hippocration HospitalSchool of MedicineAristotle University of ThessalonikiThessaloniki 54642Greece

The management policy of concomitant cholelithiasis and choledocholithiasis is based on a one-or two-stage *** basically includes either laparoscopic cholecystectomy(LC)with laparoscopic common bile duct(CBD)exploration(LCBDE)in the same operation or LC with preoperative,postoperative and even intraoperative endoscopic retrograde cholangiopancreatography-endoscopic sphincterotomy(ERCP-ES)for stone *** most frequently used worldwide option is preoperative ERCP-ES and stone removal followed by LC,preferably on the next *** cases where preoperative ERCP-ES is not feasible,the proposed alternative of intraoperative rendezvous ERCP-ES simultaneously with LC has been *** intraoperative extraction of CBD stones is superior to postoperative rendezvous ***,there is no consensus on the superiority of laparoendoscopic *** is equivalent to a traditional two-stage *** papillary large balloon dilation reduces *** and intraoperative ERCP have similar good *** risk of recurrence after ERCP-ES is greater than that after *** ultrasonography may delineate the anatomy and detect CBD *** majority of surgeons prefer the transcductal instead of the transcystic approach for CBDE with or without T-tube drainage,but the transcystic approach must be used where *** is a safe and effective choice when performed by an experienced ***,the requirement of specific equipment and advanced training are *** percutaneous approach is an alternative when ERCP *** or endoscopic reintervention for retained stones may be *** asymptomatic CBD stones,ERCP clearance is the firstchoice *** one-stage and two-stage management are acceptable and can ensure improved quality of life.

关键词： biliary diseases Cholelithiasis Choledocholithiasis Gallstones Endoscopic management Laparoscopic management

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