- [Comparative analysis of side-by-side antegrade stenting and Y-biliary stenting for malignant biliary stricture]. [Journal Article]
- KKhirurgiia (Mosk) 2018; (11):20-23
- In the time period from 2009 to 2017 in Botkin Hospital (Moscow) bilateral biliary stenting was performed in 43 patients with malignant common hepatic duct stricture. Patients were divided into 2 sta...
In the time period from 2009 to 2017 in Botkin Hospital (Moscow) bilateral biliary stenting was performed in 43 patients with malignant common hepatic duct stricture. Patients were divided into 2 statistically homogeneous groups: 'side-by-side' stenting in 28 patients and percutaneous 'Y'-biliary stent placement in 15 patients. The causes of malignant obstruction were as follows: in the 1st group 13 (46.4%) patients with extrahepatic cholangiocarcinoma (46.4%), 8 (28.6%) patients with intrahepatic cholangiocarcinoma, 4 (14.3%) patients with gallbladder cancer, 3 (10.7%) patients with metastatic cancer. In the 2nd group 6 (40%) patients with extrahepatic cholangiocarcinoma, 4 (26.6%) patients with intrahepatic cholangiocarcinoma, 2 (13.3%) patients with gallbladder cancer, 3 (20%) patients with metastatic cancer. Characteristics of patients: age - 1st group 71.2±5.1 years, 2nd group 74.3±5.5 years; sex - (m/f) 1st group 18/10, 2nd group 9/6; location of stricture - 1st group Bismuth IIIa/IIIb 17/11, 2nd group Bismuth IIIa/IIIb 11/4; mean level of bilirubin - 1st group 284±8.2 μmol/l; 2nd group 311±7.4 μmol/l. Technically all procedures were successful (100%). No complications and mortality associated with the procedure was recorded. Clinically significant results were achieved in 26 (92.8%) patients in Group 1 and in 13 (86.7%) patients in Group 2 (p=0.043). Following stenting procedures, 23 (82.1%) patients in Group 1 and 11 (68.8%) patients in the Group 2 had chemotherapy (p=0.047). 19 patients from the 1st group and 10 patients from the 2nd group died due to tumor progression of the underlying disease, other patients are under care of a physician. Median survival rate: 1st group (12 patients - 50 days, 7 patients - 100 days, 9 patients are alive at the time of writing); 2nd group (7 patients - 50 days, 4 patients - 100 days, 4 patients are alive at the time of writing). The results of this study showed that 6 (21.4%) patients from the 1st group and 4 (26.7%) patients from the 2nd group had biliary stent occlusion (p=0.041). The average period of stent function in the 1st group was 78±4.5 days, and 63±4.8 days in the 2nd group (p=0.036). Based on the obtained results, it is recommended to use the 'side-by-side' method of bilobar biliary stenting in patients with malignant common hepatic duct strictures.
- EUS-guided antegrade metal stenting with hepaticoenterostomy using a dedicated plastic stent with a review of the literature (with video). [Journal Article]
- EUEndosc Ultrasound 2018 Nov-Dec; 7(6):404-412
- CONCLUSIONS: The novel EUS-BD technique, EUS-AS using MS plus HES employing a dedicated PS, was shown to be a feasible procedure for MBO and should yield longer duration of stent patency. Furthermore, sequential antegrade stenting in cases of occluded HES seems to be one other option instead of HES stent exchange. Further large-scale comparison studies with EUS-HES or EUS-AS are required to confirm its clinical efficacy.
- A multi-institution consensus on how to perform EUS-guided biliary drainage for malignant biliary obstruction. [Journal Article]
- EUEndosc Ultrasound 2018 Nov-Dec; 7(6):356-365
- CONCLUSIONS: This is the first worldwide survey on the practice of EUS-BD for MBO. There were wide variations in practice, and randomized studies are urgently needed to establish the best approach for the management of this condition.
- [Role of medical oncologists in multidisciplinary team treatment of malignant acute abdomen]. [Journal Article]
- ZWZhonghua Wei Chang Wai Ke Za Zhi 2018 Nov 25; 21(11):1201-1205
- Acute abdomen in patients with malignant tumors is called malignant acute abdomen, often seen in the digestive system tumor or abdominal pelvic metastasis of the other primary tumors. Bleeding, perfo...
Acute abdomen in patients with malignant tumors is called malignant acute abdomen, often seen in the digestive system tumor or abdominal pelvic metastasis of the other primary tumors. Bleeding, perforation, gastrointestinal obstruction, biliary obstruction with infection, acute peritonitis are acute and severe, however, prevention is more important than treatment. For high-risk patients, even if acute abdomen does not occur when the disease is diagnosed, we should make precautions, including actively local treatment of local lymph nodes or primary lesions and careful choice of drugs. Malignant acute abdomen is mainly treated by surgical intervention. However, to seize the opportunity of anti-tumor treatment while actively treating acute abdomen requires multidisciplinary team (MDT), including co-management of diagnostic team, treatment team and support team. Most patients with malignant acute abdomen are in late stage, so the role of medical oncologists can not be ignored in the prevention, intervention and management of malignant acute abdomen. For patients with potentially resectable malignant acute abdomen who are suitable for neoadjuvant therapy and technically unresectable malignant acute abdomen, the opportunity for drug treatment should be sought first. For those presenting with obstruction, bleeding or perforation during radiotherapy or chemotherapy, we should carefully evaluate the response of previous antitumor treatment, the reason of acute abdomen and discuss the option of surgery. Some concomitant medications may also increase the risk of malignant acute abdomen. Here, we discuss the role of medical oncologists in the management of malignant acute abdomen in the MDT setting.
- Study of Percutaneous Stent Placement with Iodine-125 Seed Strand for Malignant Biliary Obstruction. [Journal Article]
- CICardiovasc Intervent Radiol 2018 Nov 30
- CONCLUSIONS: SEMS combined with iodine-125 seed strands is effective and safe in the management of MOJ and can improve stent patency and patient survival.
- YAP Activation Drives Liver Regeneration after Cholestatic Damage Induced by Rbpj Deletion. [Journal Article]
- IJInt J Mol Sci 2018 Nov 29; 19(12)
- Liver cholestasis is a chronic liver disease and a major health problem worldwide. Cholestasis is characterised by a decrease in bile flow due to impaired secretion by hepatocytes or by obstruction o...
Liver cholestasis is a chronic liver disease and a major health problem worldwide. Cholestasis is characterised by a decrease in bile flow due to impaired secretion by hepatocytes or by obstruction of bile flow through intra- or extrahepatic bile ducts. Thereby cholestasis can induce ductal proliferation, hepatocyte injury and liver fibrosis. Notch signalling promotes the formation and maturation of bile duct structures. Here we investigated the liver regeneration process in the context of cholestasis induced by disruption of the Notch signalling pathway. Liver-specific deletion of recombination signal binding protein for immunoglobulin kappa j region (Rbpj), which represents a key regulator of Notch signalling, induces severe cholestasis through impaired intra-hepatic bile duct (IHBD) maturation, severe necrosis and increased lethality. Deregulation of the biliary compartment and cholestasis are associated with the change of several signalling pathways including a Kyoto Encyclopedia of Genes and Genomes (KEGG) gene set representing the Hippo pathway, further yes-associated protein (YAP) activation and upregulation of SRY (sex determining region Y)-box 9 (SOX9), which is associated with transdifferentiation of hepatocytes. SOX9 upregulation in cholestatic liver injury in vitro is independent of Notch signalling. We could comprehensively address that in vivo Rbpj depletion is followed by YAP activation, which influences the transdifferentiation of hepatocytes and thereby contributing to liver regeneration.
- Three-Dimensional Printing Facilitates Creation of a Biliary Endoscopy Phantom for Interventional Radiology-Operated Endoscopy Training. [Journal Article]
- CPCurr Probl Diagn Radiol 2018 Aug 29
- CONCLUSIONS: The use of a three-dimensionally printed endoscopic model as a simulation tool has the potential to improve trainee comfort using endoscopy during interventional radiology procedures.
- The effect of fractal-like mechanical ventilation on vital signs in a rat model of acute-on-chronic liver failure. [Journal Article]
- PMPhysiol Meas 2018 Nov 26; 39(11):114008
- CONCLUSIONS: We suggest further investigations into the beneficial effects of fractal-like ventilation strategy in critically ill patients with liver failure requiring organ support and mechanical ventilation.
- Endoscopic Ultrasound-Guided Biliary Drainage for Unresectable Hilar Malignant Biliary Obstruction. [Journal Article]
- CEClin Endosc 2018 Nov 29
- Endoscopic transpapillary biliary drainage is the current standard of care for unresectable hilar malignant biliary obstruction (MBO) and bilateral metal stent placement is shown to have longer paten...
Endoscopic transpapillary biliary drainage is the current standard of care for unresectable hilar malignant biliary obstruction (MBO) and bilateral metal stent placement is shown to have longer patency. However, technical and clinical failure is possible and percutaneous transhepatic biliary drainage (PTBD) is sometimes necessary. Endoscopic ultrasound-guided biliary drainage (EUS-BD) is increasingly being reported as an alternative rescue procedure to PTBD. EUS-BD has a potential advantage of not traversing the biliary stricture and internal drainage can be completed in a single session. Some approaches to bilateral biliary drainage for hilar MBO under EUS-guidance include a bridging method, hepaticoduodenostomy, and a combination of EUS-BD and transpapillary biliary drainage. The aim of this review is to summarize data on EUS-BD for hilar MBO and to clarify its advantages over the conventional approaches such as endoscopic transpapillary biliary drainage and PTBD.
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- Novel metallic stent designed for endoscopic bilateral stent-in-stent placement in patients with hilar malignant biliary obstruction. [Journal Article]
- EEndoscopy 2018 Nov 23