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Clinical Advances in the Gallbladder and Biliary Tract Diseases

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A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Gastroenterology & Hepatopancreatobiliary Medicine".

Deadline for manuscript submissions: closed (15 January 2024) | Viewed by 15524

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Dr. Antonio M. Caballero-Mateos

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Guest Editor

1. Gastroenterology and Hepatology Department, San Cecilio University Hospital, 18016 Granada, Spain
2. Internal Medicine Department, Hospital Comarcal "Santa Ana", 18600 Motril, Spain
Interests: endoscopy; biliary tract diseases; pancreatic diseases; liver cirrhosis; inflammatory bowel disease
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Special Issue Information

Dear Colleagues,

Gallbladder and biliary tract diseases constitute one of the most challenging clinical issues within gastrointestinal diseases. In recent decades, innovative diagnostic tests, genetic studies, and new pharmacologic and endoscopic therapies have helped clinicians to develop a better understanding of such complex disorders. The aim of this Special Issue is to update current knowledge in this topic: the pathway from the biochemical and clinical diagnosis to the last novelties in the treatment of autoimmune, infectious, neoplastic or gallstone-related biliary diseases. We encourage you to share your scientific article in order to increase the current knowledge in this topic and implement new approaches in clinical practice.

Dr. Antonio M Caballero-Mateos
Guest Editor

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Keywords

cholangitis
biliary tract diseases
ERCP
EUS
gallstones
cholangiocarcinoma
primary biliary cholangitis
primary sclerosing cholangitis

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Published Papers (4 papers)

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Research

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13 pages, 24849 KiB

Open AccessArticle

A Short Fully Covered Self-Expandable Metal Stent for Management of Benign Biliary Stricture Not Caused by Living-Donor Liver Transplantation

by See-Young Lee, Sung-Ill Jang, Moon-Jae Chung, Jae-Hee Cho, Min-Young Do, Hye-Sun Lee, Juyeon Yang and Dong-Ki Lee

J. Clin. Med. 2024, 13(5), 1186; https://doi.org/10.3390/jcm13051186 - 20 Feb 2024

Viewed by 1861

Abstract

Background: This study evaluated the effectiveness of short fully covered self-expanding metal stents (FCSEMS) with an anti-migration design in treating benign biliary strictures (BBS) not related to living donor liver transplantation (LDLT). Methods: A retrospective analysis was conducted on 75 patients who underwent FCSEMS insertion for BBS management. Stents were initially kept for 3 months and exchanged every 3 months until stricture resolution. Adverse events and stricture recurrence after FCSEMS removal were assessed during follow-up. Results: The study outcomes were technical success, stenosis resolution, and treatment failure. Technical success was 100%, with stricture resolution in 99% of patients. The mean onset time of BBS post-surgery was 4.4 years, with an average stent indwelling period of 5.5 months. Stricture recurrence occurred in 20% of patients, mostly approximately 18.8 months after stent removal. Early cholangitis and stent migration were noted in 3% and 4% of patients, respectively. Conclusions: This study concludes that short FCSEMS demonstrate high efficacy in the treatment of non-LDLT-related BBS, with a low incidence of interventions and complications. Although this is a single-center, retrospective study with a limited sample size, the findings provide preliminary evidence supporting the use of short FCSEMS as a primary treatment modality for BBS. To substantiate these findings, further research involving multicenter studies is recommended to provide additional validation and a broader perspective. Full article

(This article belongs to the Special Issue Clinical Advances in the Gallbladder and Biliary Tract Diseases)

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11 pages, 1190 KiB

Open AccessArticle

The Role of Immunoglobulin G4 in Outcomes of Primary Sclerosing Cholangitis

by Miroslav Vujasinovic, Karouk Said, Christina Villard, Jennifer Carlsson, Christopher Poli, Patrick Maisonneuve and J.-Matthias Löhr

J. Clin. Med. 2024, 13(1), 79; https://doi.org/10.3390/jcm13010079 - 22 Dec 2023

Cited by 1 | Viewed by 1177

Abstract

Introduction: Primary sclerosing cholangitis (PSC) is a chronic, cholestatic liver disease that is characterized by an inflammatory and fibrotic process affecting bile ducts which eventually develops into liver cirrhosis and liver failure. The aim of this study was to investigate serum IgG subclass distribution in patients with PSC and its possible association with PSC outcomes. Patients and methods: We performed a retrospective analysis of 181 patients who had been diagnosed with PSC between January 1970 and December 2015 and followed at our outpatient clinic. Their demographic, immunological, and clinical characteristics were recorded and analyzed. Results: This study included 181 patients with PSC (120 males, 61 females). There was no association between IgGs and the development of autoimmune hepatitis, cirrhosis, cholangiocarcinoma, liver transplantation, inflammatory bowel disease, and colectomy. Patients with elevated IgG4 had statistically significant higher rates of cholangitis (p = 0.02) and endoscopic retrograde cholangiopancreatography (ERCP) (p = 0.009). High IgG4 values were observed in nine patients who underwent ERCP. In these nine patients, on average, IgG4 was evaluated 5 years after ERCP (min 3 days, max 11 years). Subanalysis considering only IgG4 values evaluated before ERCP showed no significant difference but remains significant if we consider IgG4 values after ERCP. Conclusion: Elevated IgG4 in our study showed a possible association with higher rates of cholangitis and ERCP among patients with primary sclerosing cholangitis. It seems that IgGs may be a useful tool for the prediction of outcomes in patients with PSC. A prospective study is necessary, especially to study the trends of IgGs values during disease as well as the role of possible seroconversion. Full article

(This article belongs to the Special Issue Clinical Advances in the Gallbladder and Biliary Tract Diseases)

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19 pages, 3563 KiB

Open AccessArticle

Impact of Altered Body Composition on Clinical and Oncological Outcomes in Intrahepatic Cholangiocarcinoma

by Guanwu Wang, Carlos C. Otto, Lara R. Heij, Tarick M. Al-Masri, Edgar Dahl, Daniel Heise, Steven W. M. Olde Damink, Tom Luedde, Sven A. Lang, Tom F. Ulmer, Ulf P. Neumann and Jan Bednarsch

J. Clin. Med. 2023, 12(24), 7747; https://doi.org/10.3390/jcm12247747 - 18 Dec 2023

Cited by 2 | Viewed by 1556

Abstract

Intrahepatic cholangiocarcinoma is a common primary liver tumor with limited treatment options and poor prognosis. Changes in body composition (BC) have been shown to affect the prognosis of various types of tumors. Therefore, our study aimed to investigate the correlation between BC and clinical and oncological outcomes in patients with iCCA. All patients with iCCA who had surgery from 2010 to 2022 at our institution were included. We used CT scans and 3D Slicer software to assess BC and conducted logistic regressions as well as Cox regressions and Kaplan–Meier analyses to investigate associations between BC and clinical variables with focus on postoperative complications and oncological outcomes. BC was frequently altered in iCCA (n = 162), with 53.1% of the patients showing obesity, 63.2% sarcopenia, 52.8% myosteatosis, 10.1% visceral obesity, and 15.3% sarcopenic obesity. The multivariate analysis showed no meaningful association between BC and perioperative complications. Myosteatosis was associated with reduced overall survival (OS) in iCCA patients (myosteatosis vs. non-myosteatosis, 7 vs. 18 months, p = 0.016 log rank). Further, the subgroup analysis revealed a notable effect in the subset of R0-resected patients (myosteatosis vs. non-myosteatosis, 18 vs. 32 months, p = 0.025) and patients with nodal metastases (myosteatosis vs. non-myosteatosis, 7 vs. 18 months, p = 0.016). While altered BC is not associated with perioperative outcomes in iCCA, myosteatosis emerges as a prognostic factor for reduced OS in the overall and sub-populations of resected patients. Full article

(This article belongs to the Special Issue Clinical Advances in the Gallbladder and Biliary Tract Diseases)

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Review

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17 pages, 1366 KiB

Open AccessReview

Early Management of Severe Biliary Infection in the Era of the Tokyo Guidelines

by Esther Nve, Josep M. Badia, Mireia Amillo-Zaragüeta, Montserrat Juvany, Mónica Mourelo-Fariña and Rosa Jorba

J. Clin. Med. 2023, 12(14), 4711; https://doi.org/10.3390/jcm12144711 - 16 Jul 2023

Cited by 6 | Viewed by 10155

Abstract

Sepsis of biliary origin is increasing worldwide and has become one of the leading causes of emergency department admissions. The presence of multi-resistant bacteria (MRB) is increasing, and mortality rates may reach 20%. This review focuses on the changes induced by the Tokyo guidelines and new concepts related to the early treatment of severe biliary disease. If cholecystitis or cholangitis is suspected, ultrasound is the imaging test of choice. Appropriate empirical antibiotic treatment should be initiated promptly, and selection should be performed while bearing in mind the severity and risk factors for MRB. In acute cholecystitis, laparoscopic cholecystectomy is the main therapeutic intervention. In patients not suitable for surgery, percutaneous cholecystostomy is a valid alternative for controlling the infection. Treatment of severe acute cholangitis is based on endoscopic or transhepatic bile duct drainage and antibiotic therapy. Endoscopic ultrasound and other new endoscopic techniques have been added to the arsenal as novel alternatives in high-risk patients. However, biliary infections remain serious conditions that can lead to sepsis and death. The introduction of internationally accepted guidelines, based on clinical presentation, laboratory tests, and imaging, provides a framework for their rapid diagnosis and treatment. Prompt assessment of patient severity, timely initiation of antimicrobials, and early control of the source of infection are essential to reduce morbidity and mortality rates. Full article

(This article belongs to the Special Issue Clinical Advances in the Gallbladder and Biliary Tract Diseases)

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