• Electrospinning
• Gemcitabine
• Heparinized stent
• Localised sustained drug delivery
• Malignant biliary obstruction
• Nanoyarns
• Self-expanding metallic stents

• Gemcitabine
• Deoxycytidine/analogs & derivatives
• Deoxycytidine/pharmacology
• Deoxycytidine/therapeutic use
• Animals
• Heparin/pharmacology
• Heparin/chemistry
• Cholestasis/pathology
• Drug-Eluting Stents
• Swine
• Self Expandable Metallic Stents
• Humans

• diagnosis
• early screening
• endoscopic ultrasound
• palliative care
• pancreatic cancer

• Biliary obstruction
• Diagnostic value
• Feasibility
• Ultrasound imaging
• Virtual endoscopy

• 82102057 National Natural Science Foundation of China
• 82071951 National Natural Science Foundation of China
• 82402297 National Natural Science Foundation of China
• 202201011157 Guangzhou Science and Technology Program

• cholangiocarcinoma
• choledochoduodenostomy
• hepaticogastrostomy
• pancreatic cancer

• Humans
• Female
• Male
• Quality of Life
• Aged
• Middle Aged
• Drainage/methods
• Prospective Studies
• Aged, 80 and over
• Adult
• Cholestasis/therapy
• Endosonography
• Cholangiopancreatography, Endoscopic Retrograde
• Palliative Care/methods
• Treatment Outcome

• electrical and electronic engineering
• biosensors

• R01 DK102663 NIDDK NIH HHS
• National Institutes of Health (R01DK102663)

• Antibiotic resistance
• Biliary obstruction
• Carbapenemase
• Cholangitis
• Extended spectrum β-lactamase

• Inside
• MBO
• Stent
• Suprapapillary

• Humans
• Cholestasis/surgery
• Cholestasis/etiology
• Stents/adverse effects
• Plastics
• Metals
• Bile Duct Neoplasms/complications
• Bile Duct Neoplasms/surgery
• Drainage/methods
• Drainage/instrumentation
• Treatment Outcome

• biliary system
• cholangioscopy
• cholecystoscopy
• cross-sectional imaging
• gallbladder
• interventional radiology
• percutaneous endoscopy

• Malignant biliary obstruction
• biliary drainage
• endoscopic retrograde cholangiopancreatography
• endoscopic ultrasound-guided drainage

• ERCP
• cholangiocarcinoma
• indeterminate biliary strictures
• malignant biliary strictures
• pancreatic ductal adenocarcinoma

• Cholangiocarcinoma
• ERCP
• Malignant biliary obstruction
• Metal stent
• Pancreatic cancer

• Humans
• Retrospective Studies
• Self Expandable Metallic Stents/adverse effects
• Cholestasis/etiology
• Cholestasis/surgery
• Stents/adverse effects
• Neoplasms
• Treatment Outcome

• Immunotherapy response
• Lung adenocarcinoma
• Molecular subtype
• Prognosis
• Single-cell RNA sequencing

• Humans
• Prognosis
• Genes, Regulator
• Adenocarcinoma of Lung/drug therapy
• Adenocarcinoma of Lung/genetics
• Phenotype
• Immunotherapy
• Lung Neoplasms/drug therapy
• Lung Neoplasms/genetics
• Tumor Microenvironment/genetics
• Membrane Proteins

• biliary obstruction
• biliopancreatic cancer
• endoscopy
• oncology
• pain
• palliation

• Ricerca corrente 2023 Ministero della Salute

• Biliary Tract Cancer
• Catheter
• Drainage
• Jaundice, Obstructive

• T-tube drainage
• choledocholithiasis
• common bile duct exploration
• internal drainage tube
• laparoscopy

• 125I seeds
• Malignant biliary obstruction
• Radioactive material
• Self-expandable metallic stent
• Tumor

• Humans
• Bismuth
• Cholestasis/etiology
• Cholestasis/surgery
• Retrospective Studies
• Treatment Outcome
• Self Expandable Metallic Stents/adverse effects
• Stents/adverse effects

• Choledochoduodenostomy
• EUS-guided biliary drainage
• Endoscopic ultrasonography
• Lumen-apposing metal stent
• Obstructive jaundice

• cyst fluid analysis
• endoscopic ultrasound
• intraductal biopsies
• pancreatic cystic lesions
• tissue sampling

Cholangiocarcinoma and small intestine cancer are common clinical malignancies, but metastatic cholangiocarcinoma and small intestine cancer are rare, especially simultaneous metastatic cholangiocarcinoma and small intestine cancer from breast cancer. Since the clinical presentation of metastatic cholangiocarcinoma and small intestine cancer does not differ from primary tumor, it may lead to misdiagnosis preoperatively.

A 66-year-old woman was admitted to our hospital for further treatment due to abdominal pain and jaundice. Abdominal magnetic resonance imaging and magnetic resonance cholangiopancreatography showed an occupying lesion of the bile duct, considering a high possibility of primary bile duct tumor. Therefore, we performed a radical bile duct cancer surgery and cholecystectomy, and multiple tumors in the small intestine were found and removed during the surgery process. Postoperative pathology showed metastatic bile duct cancer and small intestine cancer from tumors in other parts. The patient underwent a right total mastectomy and axillary lymph node dissection because of right breast cancer 2 years ago. Combining with the immunohistochemical results, the patient was finally diagnosed as metastatic cholangiocarcinoma and metastatic small intestine cancer from breast cancer. Postoperatively, the patient received four cycles of chemotherapy and targeted therapy with docetaxel, capecitabine and trastuzumab. Unfortunately, the patient eventually died from tumor progression, thoracoabdominal infection, and sepsis 5 mo after surgery.

Simultaneous metastatic cholangiocarcinoma and small intestine cancer from breast cancer are rare and the prognosis is extremely poor. Improving preoperative diagnostic accuracy is beneficial to avoid excessive surgical treatment. Treatment should be aimed at relieving biliary obstruction and abdominal pain, and then supplemented with chemotherapy and targeted therapy to control tumor progression and prolong the patient’s life.

• Breast cancer
• Metastatic cholangiocarcinoma
• Metastatic small intestine cancer
• Misdiagnosis
• Prognosis
• Case report

• Humans
• Catheter Ablation/adverse effects
• Catheter Ablation/methods
• Radiofrequency Ablation
• Cholangiopancreatography, Endoscopic Retrograde/adverse effects
• Cholestasis/diagnostic imaging
• Cholestasis/etiology
• Cholestasis/surgery
• Stents/adverse effects
• Bile Duct Neoplasms/complications
• Bile Duct Neoplasms/diagnostic imaging
• Bile Duct Neoplasms/surgery
• Treatment Outcome

• covered self-expandable metal stents
• efficacy
• malignant distal biliary stricture
• safety
• uncovered self-expandable metal stents

Palliative endoscopic biliary drainage is the primary treatment option for the management of patients with jaundice which results from distal malignant biliary obstruction (DMBO). In this group of patients, decompression of the bile duct (BD) allows for pain reduction, symptom relief, chemotherapy administration, improved quality of life, and increased survival rate. To reduce the unfavorable effects of BD decompression, minimally invasive surgical techniques require continuous improvement.

To develop a technique for internal-external biliary-jejunal drainage (IEBJD) and assess its effectiveness in comparison to other minimally invasive procedures in the palliative treatment of patients with DMBO.

A retrospective analysis of prospectively collected data was performed, which included 134 patients with DMBO who underwent palliative BD decompression. Biliary-jejunal drainage was developed to divert bile from the BD directly into the initial loops of the small intestine to prevent duodeno-biliary reflux. IEBJD was carried out using percutaneous transhepatic access. Percutaneous transhepatic biliary drainage (PTBD), endoscopic retrograde biliary stenting (ERBS), and internal-external transpapillary biliary drainage (IETBD) were used for the treatment of study patients. Endpoints of the study were the clinical success of the procedure, the frequency and nature of complications, and the cumulative survival rate.

There were no significant differences in the frequency of minor complications between the study groups. Significant complications occurred in 5 (17.2%) patients in the IEBJD group, in 16 (64.0%) in the ERBS group, in 9 (47.4%) in the IETBD group, and in 12 (17.4%) in the PTBD group. Cholangitis was the most common severe complication. In the IEBJD group, the course of cholangitis was characterized by a delayed onset and shorter duration as compared to other study groups. The cumulative survival rate of patients who underwent IEBJD was 2.6 times higher in comparison to those of the PTBD and IETBD groups and 20% higher in comparison to that of the ERBS group.

IEBJD has advantages over other minimally invasive BD decompression techniques and can be recommended for the palliative treatment of patients with DMBO.

• Distal malignant biliary obstruction
• Obstructive jaundice
• Bile duct decompression
• Palliative endoscopic biliary drainage
• Internal-external biliary-jejunal drainage

• Cholangiograpy
• Cholestases
• Klatskins tumors
• Perihiliar cholangiocarcinoma
• Radiology

• Humans
• Klatskin Tumor/complications
• Klatskin Tumor/surgery
• Bismuth
• Cholestasis/etiology
• Cholestasis/surgery
• Drainage/adverse effects
• Postoperative Complications/epidemiology
• Bile Duct Neoplasms/complications
• Bile Duct Neoplasms/surgery

Malignant biliary obstruction often presents with challenges requiring the endoscopist to assess the location of the lesion, the staging of the disease, the eventual resectability and patient preferences in term of biliary decompression. This review will focus on the different modalities available in order to offer the most appropriate palliation, such as conventional endoscopic retrograde cholangiopancreatography, endoscopic ultrasound guided biliary drainage as well as ablative therapies including photodynamic therapy or radiofrequency ablation.

• Biliary obstruction
• Endoscopic retrograde cholangiopancreatography
• Endoscopic ultrasonography
• Stenting
• Ablation therapy

• distal cholangiocarincoma
• hepatobiliary
• malignancy

• Bile Duct Neoplasms/surgery
• Bile Ducts, Intrahepatic/pathology
• Cholangiocarcinoma/pathology
• Cholangiocarcinoma/surgery
• Combined Modality Therapy
• Humans
• Neoadjuvant Therapy

• lung cancer
• metabolic reprogramming

• Biliary
• bypass
• jaundice
• low resource
• malignant
• obstruction
• palliation

Artificial intelligence (AI) is the timeliest field of computer science and attempts to mimic cognitive function of humans to solve problems. In the era of “Big data”, there is an ever-increasing need for AI in all aspects of medicine. Cholangiocarcinoma (CCA) is the second most common primary malignancy of liver that has shown an increase in incidence in the last years. CCA has high mortality as it is diagnosed in later stages that decreases effect of surgery, chemotherapy, and other modalities. With technological advancement there is an immense amount of clinicopathologic, genetic, serologic, histologic, and radiologic data that can be assimilated together by modern AI tools for diagnosis, treatment, and prognosis of CCA. The literature shows that in almost all cases AI models have the capacity to increase accuracy in diagnosis, treatment, and prognosis of CCA. Most studies however are retrospective, and one study failed to show AI benefit in practice. There is immense potential for AI in diagnosis, treatment, and prognosis of CCA however limitations such as relative lack of studies in use by human operators in improvement of survival remains to be seen.

• Artificial intelligence
• Machine learning
• Cholangiocarcinoma
• Diagnosis
• Treatment
• Prognosis

Magnetic resonance cholangiopancreatography (MRCP) is a noninvasive method to detect pancreaticobiliary strictures. In this study, we aimed to evaluate the diagnostic performance of MRCP and detect sensitive and specific radiologic features in distinguishing malignant and benign pathologies.

In this study, 50 patients with biliary obstruction and a confirmed diagnosis using histopathology were included. The pathologies were evaluated using MRCP which were categorized into malignant and benign strictures. The etiology of strictures was detected using histopathology and endoscopic retrograde cholangiopancreatography. The diagnostic performance of MRCP was calculated using SPSS software. P < 0.05 was considered statistically significant.

Of 50 patients, 23 patients (46%) had malignant strictures based on MRCP and histopathology. The sensitivity and specificity of MRCP to detect malignancy were 95.7% and 96.3%, respectively. The most sensitive MRCP features to detect malignancy were upstream biliary duct dilation, abrupt tapering, and the presence of a solid mass with sensitivity 100%, 95.7%, and 78.2%, respectively. The malignancy rate was significantly higher in the strictures with length >11.5 mm or wall thickness >2.75 mm (P < 0.05).

MRCP is a sensitive method to differentiate malignant lesions from benign pathologies. A long and thick stricture with the presence of a solid mass, upstream biliary duct dilation, and abrupt tapering is highly suggestive of malignancy.

• Biliary tract
• Cholangiopancreatography
• Magnetic Resonance
• malignancy
• pancreas

• case report
• cholangiocarcinoma
• inflammatory secretion
• obstructive jaundice

• Aged
• Bile Duct Neoplasms/complications
• Bile Duct Neoplasms/diagnosis
• Bile Duct Neoplasms/surgery
• Cholangiocarcinoma/complications
• Cholangiocarcinoma/diagnosis
• Cholangiocarcinoma/surgery
• Cholangiopancreatography, Endoscopic Retrograde
• Cholestasis
• Drainage
• Female
• Humans
• Jaundice, Obstructive/etiology
• Mucus
• Quality of Life

• Biliary stricture
• Liver transplant
• Percutaneous transhepatic radiologic intervention

• Aged
• Cholangiopancreatography, Endoscopic Retrograde/methods
• Cholangitis/therapy
• Cholestasis, Extrahepatic/therapy
• Constriction, Pathologic/therapy
• Drainage/methods
• Female
• Humans
• Male
• Retrospective Studies

• Biliary obstruction
• Malignancy
• Palliation
• Pancreatic cancer
• Survival

Biliary stenosis may represent a diagnostic and therapeutic challenge resulting in a delay in diagnosis and initiation of therapy due to the frequent difficulty in distinguishing a benign from a malignant stricture. In such cases, the diagnostic flowchart includes the sequential execution of imaging techniques, such as magnetic resonance, magnetic resonance cholangiopancreatography, and endoscopic ultrasound, while endoscopic retrograde cholangiopancreatography is performed to collect tissue for histopathological/cytological diagnosis or to treat the stenosis by insertion of stent. The execution of percutaneous transhepatic drainage with subsequent biopsy has been shown to increase the possibility of tissue diagnosis after failure of the above techniques. Although the diagnostic yield of histopathology and imaging has increased with improvements in endoscopic ultrasound and peroral cholangioscopy, differential diagnosis between malignant and benign stenosis may not be easy in some patients, and strictures are classified as indeterminate. In these cases, a multidisciplinary workup including biochemical marker assays and advanced technologies available may speed up a diagnosis of malignancy or avoid unnecessary surgery in the event of a benign stricture. Here, we review recent advancements in the diagnosis and management of biliary strictures and describe tips and tricks to increase diagnostic yields in clinical routine.

• Biliary stenosis
• Cholangioscopy
• Metal stent
• Endoscopic ultrasound
• Endoscopic ultrasound-guided fine needle aspiration
• Biliary stenosis treatment

Fully covered self-expandable metal stents (FCSEMS) represent the latest advancement of metal biliary stents used to endoscopically treat a variety of obstructive biliary pathology. A large stent diameter and synthetic covering over the tubular mesh prolong stent patency and reduce risk for tissue hyperplasia and tumor ingrowth. Additionally, FCSEMS can be easily removed. All these features address issues faced by plastic and uncovered metal stents. The purpose of this paper is to comprehensively review the application of FCSEMS in benign and malignant biliary strictures, biliary leak, and post-sphincterotomy bleeding.

• Fully covered self-expandable metal stents
• Plastic stents
• Endoscopy
• Chronic pancreatitis
• Biliary stricture
• Biliary leak
• Stent migration

• Biliary Tract Surgical Procedures/adverse effects
• Cholangiopancreatography, Endoscopic Retrograde
• Cholestasis/etiology
• Humans
• Metals
• Self Expandable Metallic Stents
• Stents
• Treatment Outcome

To determine whether contrast-enhanced computed tomography (CT) can promote the identification of malignant and benign distal biliary strictures (DBSs) compared to the use of magnetic resonance cholangiopancreatography (MRCP) alone and to identify imaging findings of malignant DBSs.

A total of 168 consecutive patients with confirmed DBSs were reviewed. MRCP alone and MRCP combined with CT images were blindly analyzed by two radiologists (e.g., stricture pattern, margins), and malignant or benign DBSs were identified based on surgical findings, endoscopy findings, or follow-up. The diagnostic accuracy of the two reviewers using MRCP alone and MRCP combined with CT were evaluated. MRCP and CT features of malignant and benign DBSs were compared using multiple logistic regression analysis to identify independent malignant risk factors.

MRCP combined with CT examination could improve the diagnostic accuracy, which increased from 70.2% to 81.5% in Doctor A and from 85.1% to 89.3% in Doctor B. The multiple logistic regression model revealed that stricture length [odds ratio (OR) 1.070, P=0.016], angle of the DBS (OR 1.061, P<0.001), double duct sign (OR 4.312, P=0.003) and low density in the arterial phase (OR 0.319, P=0.018) were associated with malignant DBS. A scoring model incorporating these four factors was established; at a threshold value of 1.75, and the sensitivity and specificity for the detection of malignant DBSs were 73.5 and 85.9%, respectively.

Compared to the use of MRCP alone, MRCP combined with contrast-enhanced CT can improve the accuracy of DBS diagnosis. The scoring model accurately predicts malignant DBSs and helps make treatment decisions.

• CT
• MRCP
• distal biliary strictures
• imaging findings
• risk factors

• biliary strictures
• hyperbilirubinemia
• medical management

• Biliary malignancies
• Difficult conversation
• Futility of care
• Malignant obstructive jaundice
• Surgical palliative care

Breast cancer is the most common tumor in women, and about one-third of cases develop metastatic disease. However, metastatic breast cancer rarely invades the common bile duct (CBD) directly without involving the liver, and involvement of the gastrointestinal tract is rare. Cases of such metastases pose a particular diagnostic challenge.

A 55-year-old female presented to the Department of Gastroenterology with complaint of a 2 mo history of right upper abdominal pain accompanied by pain in the right back, aggravated after eating greasy diet. The patient had received a diagnosis of breast cancer 3 years prior. Physical examination showed obvious superficial protuberant erythema on the left neck and chest skin, with slight tenderness and burning sensation. Endoscopic retrograde cholangiopancre-atography showed an obstruction at the end of the CBD. Histopathology of the CBD and symptomatic skin biopsies showed positivity for cytokeratin 7 and trans-acting T-cell-specific transcription factor breast cancer biomarkers. A cancer embolus was also found in the skin vasculature. Accordingly, the diagnosis of breast cancer metastases to the skin and biliary ducts was made. A plastic biliary sent was placed, which relieved the right upper abdominal pain and protected against unnecessary hepatectomy surgery.

Although rare, biliary metastasis should be considered in patients with bile duct stenosis and a history of breast cancer.

• Breast cancer
• Common bile duct
• Metastases
• Plastic stent
• Prognosis
• Case report

• ERCP
• cell-free DNA
• cholangiocarcinoma
• liquid biopsy
• next generation sequencing
• pancreatic cancer

• N° 824946 European Commission
• Forschungskommission 2018-29 Faculty of Medicine, Heinrich-Heine University of Duesseldorf

• CBD, common bile duct
• FC-SEMS, fully covered self-expandable metal stent

Given most patients with distal malignant biliary obstruction present in the non-resectable stage, palliative endoscopic biliary drainage with fully covered metal stent (FCMS) or uncovered metal stent (UCMS) is the only available measure to improve patients’ quality of life. Half covered metal stent (HCMS) has been recently introduced commercially. The adverse effects and stent function between FCMS and UCMS have been extensively discussed.

To study the duration of stent patency of HCMS and compare it with FCMS and UCMS to optimize biliary drainage in inoperable patients with distal malignant obstruction. Secondary aims in our study included evaluation of patients’ survival and the rates of adverse events for each type of stent.

We studied 210 patients and randomized them into three equal groups; HCMS, FCMS and UCMS were inserted endoscopically.

Stent occlusion occurred in (18.6%, 17.1% and 15.7% in HCMS, FCMS and UCMS groups, respectively, P = 0.9). Stent migration occurred only in patients with FCMS (8.6% of patients). Cholangitis and cholecystitis occurred in 11.4% and 5.7% of patients, respectively, in FCMS. Tumor growth occurred only in 10 cases among patients with UCMS after a median of 140 d, sludge occurred in nine, seven and one patients in HCMS, FCMS and UCMS, respectively (P = 0.04).

Given the prolonged stent functioning time, the use of HCMS is preferred over the use of UCMS and FCMS for optimizing biliary drainage in patients with distal malignant biliary obstruction.

• Obstructive jaundice
• Endoscopic retrograde cholangio-pancreatography
• Half covered metal stent
• Fully covered and uncovered metal stents

• endoscopic management
• endoscopic ultrasound-guided biliary drainage
• hepatobiliary malignancy
• hilar stricture
• malignant biliary stricture
• pancreatic cancer
• radiofrequency ablation
• self-expandable metal stent

The differential diagnosis for biliary strictures is broad. However, the likelihood of malignancy is high. Determining the etiology of a biliary stricture requires a comprehensive physical exam, laboratory evaluation, imaging, and ultimately tissue acquisition. Even then, definitive diagnosis is elusive, and many strictures remain indeterminant in origin. This literary review examines the diagnostic dilemma of biliary strictures and presents innovations in both histochemical and endoscopic techniques that have increased the diagnostic power of differentiating benign and malignant strictures. The field of tissue biopsy is revolutionizing with the advent of free DNA mutation profiling, fluorescence in situ hybridization (FISH), and methionyl t-RNA synthetase 1 (MARS 1), which allow for greater testing sensitivity. Endoscopic ultrasound, endoscopic retrograde cholangiopancreatography (ERCP), cholangioscopy, confocal laser endomicroscopy, and intraductal ultrasound build upon existing endoscopic technology to better characterize strictures that would otherwise be indeterminate in etiology. This review uses recent literature to insert innovative technology into the traditional framework of diagnostic methods for malignant biliary strictures.

• cholangioscopy
• confocal laser endomicroscopy
• endoscopic retrograde cholangiopancreatography
• endoscopic ultrasound
• fine-needle aspiration and biopsy
• hepatobiliary malignancy
• intraductal ultrasound
• malignant biliary stricture
• pancreatic cancer

• Ampulla of Vater
• Carcinomas
• Diagnosis
• Magnetic resonance imaging
• Positron emission tomography