Search

Background: Percutaneous Trans hepatic biliary drainage (PTBD) is a successful palliative treatment for malignant obstructive jaundice. Despite the past that PTBD complications occur more frequently. Currently, with the help of an ultrasound guide, these side effects and possibility of adjacent organ damages have decreased interestingly. One of the rare complications of this procedure is acute pancreatitis. Case Presentation: We discuss an uncommon case of acute pancreatitis following PTBD in an elderly woman who presented to the hospital with jaundice and anorexia. Conservative therapy without decatheterization was the treatment of choice in our patient. Eventually after receiving conservative therapy for her pancreatitis, she was discharged from the hospital in good general condition and she has not experienced any episodes of abdominal pain again. Conclusion: Acute pancreatitis is one of the causes of sepsis during PTBD catheterization. Early management of this complication after PTBD can decrease morbidity and mortality of the patients. [ABSTRACT FROM AUTHOR]

Abstract The risk of cholangitis after ERCP implantation in malignant obstructive jaundice patients remains unknown. To develop models based on artificial intelligence methods to predict cholangitis risk more accurately, according to patients after stent implantation in patients’ MOJ clinical data. This retrospective study included 218 patients with MOJ undergoing ERCP surgery. A total of 27 clinical variables were collected as input variables. Seven models (including univariate analysis and six machine learning models) were trained and tested for classified prediction. The model’ performance was measured by AUROC. The RFT model demonstrated excellent performances with accuracies up to 0.86 and AUROC up to 0.87. Feature selection in RF and SHAP was similar, and the choice of the best variable subset produced a high performance with an AUROC up to 0.89. We have developed a hybrid machine learning model with better predictive performance than traditional LR prediction models, as well as other machine learning models for cholangitis based on simple clinical data. The model can assist doctors in clinical diagnosis, adopt reasonable treatment plans, and improve the survival rate of patients.

The risk of cholangitis after ERCP implantation in malignant obstructive jaundice patients remains unknown. To develop models based on artificial intelligence methods to predict cholangitis risk more accurately, according to patients after stent implantation in patients' MOJ clinical data. This retrospective study included 218 patients with MOJ undergoing ERCP surgery. A total of 27 clinical variables were collected as input variables. Seven models (including univariate analysis and six machine learning models) were trained and tested for classified prediction. The model' performance was measured by AUROC. The RFT model demonstrated excellent performances with accuracies up to 0.86 and AUROC up to 0.87. Feature selection in RF and SHAP was similar, and the choice of the best variable subset produced a high performance with an AUROC up to 0.89. We have developed a hybrid machine learning model with better predictive performance than traditional LR prediction models, as well as other machine learning models for cholangitis based on simple clinical data. The model can assist doctors in clinical diagnosis, adopt reasonable treatment plans, and improve the survival rate of patients. [ABSTRACT FROM AUTHOR]

Abstract The main cause of distal biliary malignant obstructive jaundice (DBMOJ) is the stricture of the extrahepatic biliary tract by malignant tumors, including pancreatic head and uncinate process cancer, low-grade cholangiocarcinoma, duodenal cancer, papillary duodenal cancer and other malignant tumors. The most effective treatment is radical pancreaticoduodenectomy. However, preoperative obstructive jaundice can affect the patient’s liver function and blood coagulation function, increase local inflammation and oedema, and make surgery more difficult. Patients with severe obstructive jaundice require preoperative biliary drainage, which can be achieved by various methods, including ultrasound endoscopic biliary drainage (EUS-EBD) and endoscopic retrograde biliary drainage (ERBD). The latter is mainly divided into endoscopic nasobiliary drainage and endoscopic biliary stent. Some patients underwent percutaneous transhepatic biliary drainage (PTBD) when ERBD and EUS-EBD failed. In this study, we aimed to identify PTBD in DBMOJ and to further investigate the role of the puncture pathway in DBMOJ. The relationship between PTBD and bile duct internal diameter was confirmed by analysing and collating clinical data. In this study, DBMOJ was grouped according to bile duct internal diameter and liver function was used as an indicator to examine the improvement in liver function with PTBD in patients undergoing DBMOJ. Analysis of puncture complications showed that PTBD puncture was safe. DBMOJ with different bile duct internal diameters had different rates of liver function improvement after PTBD. The right-side approaches had significantly lower alanine aminotransferase (ALT) and alanine transaminase (AST) than the left-side approaches. This study showed that PTBD for DBMOJ is associated with a low complication rate and good reduction of jaundice. Liver function recovery was faster in patients with DBMOJ treated with PTBD in the right-sided approach compared with the left-sided approach. PTBD is an effective tool to be used in patients who have failed ERBD and EUS-EBD.

The main cause of distal biliary malignant obstructive jaundice (DBMOJ) is the stricture of the extrahepatic biliary tract by malignant tumors, including pancreatic head and uncinate process cancer, low-grade cholangiocarcinoma, duodenal cancer, papillary duodenal cancer and other malignant tumors. The most effective treatment is radical pancreaticoduodenectomy. However, preoperative obstructive jaundice can affect the patient's liver function and blood coagulation function, increase local inflammation and oedema, and make surgery more difficult. Patients with severe obstructive jaundice require preoperative biliary drainage, which can be achieved by various methods, including ultrasound endoscopic biliary drainage (EUS-EBD) and endoscopic retrograde biliary drainage (ERBD). The latter is mainly divided into endoscopic nasobiliary drainage and endoscopic biliary stent. Some patients underwent percutaneous transhepatic biliary drainage (PTBD) when ERBD and EUS-EBD failed. In this study, we aimed to identify PTBD in DBMOJ and to further investigate the role of the puncture pathway in DBMOJ. The relationship between PTBD and bile duct internal diameter was confirmed by analysing and collating clinical data. In this study, DBMOJ was grouped according to bile duct internal diameter and liver function was used as an indicator to examine the improvement in liver function with PTBD in patients undergoing DBMOJ. Analysis of puncture complications showed that PTBD puncture was safe. DBMOJ with different bile duct internal diameters had different rates of liver function improvement after PTBD. The right-side approaches had significantly lower alanine aminotransferase (ALT) and alanine transaminase (AST) than the left-side approaches. This study showed that PTBD for DBMOJ is associated with a low complication rate and good reduction of jaundice. Liver function recovery was faster in patients with DBMOJ treated with PTBD in the right-sided approach compared with the left-sided approach. PTBD is an effective tool to be used in patients who have failed ERBD and EUS-EBD. [ABSTRACT FROM AUTHOR]

Objective: The purpose of this study was to explore the clinical benefits of establishing an enteral nutrition (EN) pathway via percutaneous transhepatic cholangiography drainage (PTCD) catheterization in patients with late-stage malignant obstructive jaundice (MOJ).Methods: We selected 30 patients diagnosed as having late-stage MOJ with malnutrition. A dual-lumen biliary-enteral nutrition tube was placed via PTCD along with a biliary stent implantation. Postoperative EN was provided, and we observed the time taken for tube placement, its success rate, complications, and therapeutic efficacy.Results: Tube placement was successful in all 30 patients with an average procedural time of 5.7 ± 1.4 min with no tube placement complications. Compared to preoperative measures, there was a significant improvement in postoperative jaundice reduction and nutritional indicators one month after the procedure (p < 0.05). Post-placement complications included tube perileakage in 5 cases, entero-biliary reflux in 4 cases, tube blockage in 6 cases, tube displacement in 4 cases, accidental tube removal in 3 cases, and tube replacement due to degradation in 8 cases, with tube retention time ranging from 42 to 314 days, averaging 124.7 ± 37.5 days. All patients achieved the parameters for effective home-based enteral nutrition with a noticeable improvement in their quality of life.Conclusion: In this study, we found that the technique of establishing an EN pathway via PTCD catheterization was minimally invasive, safe, and effective; the tube was easy to maintain; and patient compliance was high. It is, thus, suitable for long-term tube retention in patients with late-stage MOJ. [ABSTRACT FROM AUTHOR]

Purpose: Malignant biliary obstruction (MBO) is common in patients with advanced malignant tumors, leading to poor prognosis and hindering antitumor therapy. The purpose of our study was to assess the survival outcomes for patients under therapy after percutaneous transhepatic biliary drainage (PTBD) and identify prognostic factors associated with survival in patients with MBO. Methods: From July 2010 to February 2021, 269 patients with MBO secondary to malignant tumor were divided into two groups (functional success and non-functional success). Survival time and prognostic factors were analyzed by Kaplan–Meier curves and the Cox model. Results: The overall median survival time after PTBD was 4.6 months (95 % IC:3.9–5.3). The 3- and 6-month survival rates were 68.0 % and 38.7 %, respectively. The median survival improved from 3.2 months to 8.4 months when the procedure achieved functional success. Multivariate analysis demonstrated that functionally successful drainage and antitumor treatment after PTBD were independent positive prognostic factors, but the total bilirubin after drainage and tumor size were independent negative predictive values. Conclusions: Functionally successful drainage could prolong survival time in patients with malignant biliary obstruction. Palliative care after drainage can prolong patient survival and improve their quality of life.

A total of 120 patients admitted to affiliated hospitals of the North Sichuan Medical College between September 2020 and June 2022 were recruited for this study and received percutaneous transhepatic cholangial drainage. Patients in the control group received parenteral nutrition support, whereas patients in the treatment group received parenteral and combined enteral nutrition support. Compared to the control group, the time of first exhaustion and defecation in the treatment group was faster, and the postoperative activity time and hospital stay were shorter. Serum albumin and prealbumin levels in both groups decreased on the 1st day after surgery and recovered on the 7th day, with the treatment group reaching higher levels. After surgery, the decline in alanine aminotransferase, aspartate aminotransferase, total bilirubin, and direct bilirubin levels was higher in the treatment group. CD4+, CD8+ levels, and CD4+/CD8+ ratios in both groups were elevated, with the treatment group showing higher levels. The occurrence of complications in the treatment group was lessened relative to the control group. In summary, enteral combined parenteral nutrition support for patients with malignant obstructive jaundice after surgery can promote faster recovery of gastrointestinal function, improve nutritional status, facilitate the recovery of liver function, and promote immune function. [ABSTRACT FROM AUTHOR]

To compare the safety and efficacy of intraluminal brachytherapy with iodine-125 (125I) seed strand implantation combined with and without stent placement to treat patients with obstructive jaundice induced by tumor thrombus. Between January 2018 and June 2022, 42 patients with malignant obstructive jaundice (MOJ) induced by tumor thrombus were included. 20 patients received 125I seed strand implantation and stent placement (group A). The remaining 22 patients, implanted 125I seed strands only, served as control (group B). The two groups' overall survival and jaundice-free survival were compared using the Kaplan-Meier method and log-rank test. During the follow-up period, the mean survival time of group A was 38.0 ± 4.1 months (95%CI, 30.0–46.1 months), while that of group B was 25.1 ± 2.8 (95% CI, 19.5–30.6 months) (p = 0.406). The mean survival rates of 12 months for all patients, group A, and group B was 66.7%, 65%, and 68%, respectively. The mean jaundice-free survival of group A and group B were 34.0 ± 3.6 months (95% CI, 27.9–41.2months) and 22.9 ± 2.7 months (95%CI, 17.5–28.2months) (p = 0.254), respectively. Two PTBD drainage tube infection cases occurred in group A and group B separately. 125I intraluminal brachytherapy is an effective and safe therapy for treating patients with obstructive jaundice induced by tumor thrombus. [ABSTRACT FROM AUTHOR]

Objective To investigate the predictive value of dynamic changes in serum prealbumin (PAB) in the treatment of malignant obstructive jaundice (MOJ) with the first endoscopic retrograde cholangiopancreatography (ERCP) biliary stenting. Methods The clinical data of 119 patients with MOJ who were relieved by ERCP stenting for the first time were retrospectively analyzed. Patients were divided into the survival group and the death group according to whether their survival period was greater than 1 year. The liver function indexes of patients before and 7 days after surgery were collected, and the dynamic change rate of PAB (7 d after surgery/preoperative) was calculated. The receiver operating characteristic (ROC) curve was used to determine the best cut-off value of the dynamic change rate of PAB. Patients were divided into two groups according to the cut-off value. The survival curves of the two groups were plotted by K-M method, and risk factors affecting the long-term survival prognosis of patients were analyzed by the Cox proportional hazard model. Results The 1- year survival rate of 119 patients was 45.4% (54/119) and the case fatality rate was 54.6% (65/119). The dynamic rate of PAB was 1.1 (0.9, 1.4) in the survival group, and 0.9 (0.7, 1.0) in the death group, which was significantly higher in the survival group than that in the death group (P＜0.05). ROC analysis showed that the area under the ROC curve was 0.799 （95% CI：0.704-0.895）and the optimal cut-off value of PAB dynamic rate was 1.008, and the survival analysis showed that the one-year survival rate of the group with high PAB dynamic rate was significantly higher than that in the group with low PAB dynamic rate (P＜0.01). Multivariate analysis showed that low dynamic rate of PAB was an independent risk factor for long-term survival of patients with MOJ after ERCP. Conclusion The dynamic rate of PAB can be used as a potential prognostic indicator for MOJ patients. [ABSTRACT FROM AUTHOR]

Abstract Background Several previous studies demonstrated that the combination of self-expandable metallic stents (SEMS) and 125I seed implantation might prolong stent patency and obtain survival benefits for malignant obstructive jaundice (MOJ) patients. However, these studies rarely mentioned a comparison between CT-guided intratumoral 125I seed implantation and intraluminal 125I seed strand insertion combined with stenting for the management of MOJ. This study aimed to further evaluate the safety and efficacy of SEMS combined with 125I brachytherapy in the management of unresectable MOJ. Methods Fifty-nine patients with unresectable MOJ were retrospectively included from March 2018 to June 2021. The main therapeutic outcomes were evaluated in terms of stent patency, and overall survival. Cumulative stent patency and overall survival rates were calculated by Kaplan–Meier survival analysis. Both clinical and treatment factors associated with survival were analyzed. Results Technical success was achieved in all patients. The clinical success rate was 94% (32/34) in the seeds group and 92% (23/25) in the control group, no significant difference was found (p =1.000). The median duration of stent patency was significantly longer in the 125I brachytherapy group compared with the control group (289 days vs. 88 days, respectively, p =0.001). The 125I brachytherapy group demonstrated a significantly better median overall survival rate than the control group (221 days vs. 78 days, respectively, p =0.001). In multivariate analysis, stents with 125I brachytherapy (p =0.004) was a significant favorable prognostic factor that affected patient survival. No significant difference was observed between CT-guided 125I seed implantation and 125I seed strand insertion in stent patency (p =0.268), and overall survival (p =0.483). Conclusion SEMS combined with 125I brachytherapy is safe and effective for treating MOJ. 125I brachytherapy may help to maintain stent patency and prolong overall survival. There was no significant difference between CT-guided 125I seed implantation with SEMS and 125I seed strand insertion with SEMS in stent patency and overall survival.

Objective: To evaluate the long-term inhibition of malignant biliary tumor growth using paclitaxel (PTX)-covered polycaprolactone (PCL) electrospun membranes. Methods: A mixture of PCL, a material used to fabricate polymer stents, and PTX, a widely used chemotherapeutic agent, was synthesized by electrospinning. After preparing the drug-eluting membrane, drug release and fiber degradation were assessed in vitro under different pH conditions. The QBC939 cholangiocarcinoma cell line was cultured to establish a xenograft nude mouse model. Finally, the drug-eluting membrane was implanted into the mouse model, and the relative tumor inhibition rate was evaluated. Results: A new PTX-loaded PCL electrospun fiber membrane was developed. The drug release rate was about 20–40% in the 32-day release cycle, and the release quantity was between 20 and 170 mg. As pH decreased, the release rate increased significantly. The degradation rate of the fiber membranes in vitro was approximately 20–48%, and was positively correlated with the drug loading rate. In animal experiments, the growth of tumors in mice was suppressed using drug-eluting membranes. Conclusion: The PTX-loaded PCL electrospun fiber membrane enhanced the long-term drug release and exhibited excellent antitumor effects in vivo.

Background: At present, endoscopic retrograde cholangiopancreatography (ERCP) and percutaneous transhepatic cholangial drainage (PTCD) are frequently used for reducing malignant obstructive jaundice (MOJ). However, it is controversial as to which method is superior in terms of efficacy and safety. Objectives: The aim of this study was to compare the safety, feasibility, and clinical benefits of ERCP and PTCD in matched cases of MOJ. Methods: The Web of Science, Cochrane, PubMed, and CNKI databases were searched systematically to identify studies published between January 2000 and December 2019, without language restrictions, that compared ERCP and PTCD in patients with MOJ. The primary outcome was the success rate for each procedure. The secondary outcomes were the technical success rate, serum total bilirubin level, length of hospital stay, hospital expense, complication rate, and survival. This meta-analysis was performed using Review Manager 5.3. Results: Sixteen studies met the inclusion criteria, including 1,143 cases of ERCP and 854 cases of PTCD. The analysis demonstrated that jaundice remission in PTCD was equal to that in ERCP (mean difference [MD], 1.19; 95% confidence interval [CI]: −0.56 to –2.93; p = 0.18). However, the length of hospital stay in the ERCP group was 3.03 days shorter than that in the PTCD group (MD, −2.41; 95% CI: −4.61 to −0.22; p = 0.03). ERCP had a lower rate of postoperative complications (odds ratio, 0.66; 95% CI: 0.42–1.05); however, the difference was not significant (p = 0.08). ERCP was also more cost-efficient (MD, −5.42; 95% CI: −5.52 to −5.32; p < 0.01). Further, we calculated the absolute mean of hospital stay (ERCP:PTCD = 8.73:12.95 days), hospital expenses (ERCP:PTCD = 5,104.13:5,866.75 RMB), and postoperative complications (ERCP:PTCD = 11.2%:9.1%) in both groups. Conclusion: For remission of MOJ, PTCD and ERCP had similar clinical efficacy. Each method has its own strengths and weaknesses. Considering that ERCP had a lower rate of postoperative complications, shorter hospital stay, and higher cost efficiency, ERCP may be a superior initial treatment choice for MOJ. [ABSTRACT FROM AUTHOR]

Purpose: To compare the survival prognosis of percutaneous transhepatic biliary stenting (PTBS) in the treatment of malignant obstructive jaundice (MOJ) at different horizontal sites. Methods: A total of 120 patients with MOJ who underwent biliary stenting were retrospectively included and analyzed and divided into the high‑position group (36 patients), middle‑position group (43 patients), and low‑position group (41 patients) according to biliary obstruction plane by biliary anatomy. Kaplan–Meier curves were used to test for differences in the overall survival (OS), risk assessment of death and potential risk factors for 1‑year survival were analyzed using multifactorial Cox regression. Results: The median survival of the high‑, middle‑, low‑position groups were 16, 8.6, and 5.6 months, with a statistically significant difference (P = 0.017). The 1‑year survival rate was 67.6%, 41.9%, and 41.5% in the high‑, middle‑, low‑position groups (P < 0.05), and the 1‑year risk of death was 2.35 and 2.93 times higher in the medium‑ and low‑position groups, respectively. The incidences of the main complications were 25%, 48.8%, and 65.9% in the high‑, middle‑, and low‑position groups, respectively, (P = 0.002). While the differences in median stent patency were not statistically significant (P > 0.05) in the groups, alanine transaminase, aspartate transaminase, and total bilirubin levels decreased gradually in each group at 1 month and 3 months after interventional therapy (P < 0.001), while there was no significant difference in the decrease between the groups. Conclusions: Different levels of biliary obstruction in patients with MOJ affect survival, especially at 1 year, where high obstruction treated with PTBS has a low incidence of complications and a low risk of death. [ABSTRACT FROM AUTHOR]

Charles Newton Odongo,1 Carlos Cabrera Dreque,2 David Mutiibwa,2 Felix Bongomin,3 Felix Oyania,4 Mvuyo Maqhawe Sikhondze,2 Moses Acan,2 Raymond Atwine,2 Fred Kirya,1 Martin Situma2 1Department of Anatomy, Faculty of Medicine, Soroti University, Soroti, Uganda; 2Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda; 3Department of Microbiology and Immunology, and Internal Medicine, Faculty of Medicine, Gulu University, Gulu, Uganda; 4Department of Surgery, Faculty of Medicine, Kabale University, Kabale, UgandaCorrespondence: Charles Newton Odongo, Tel +256774849032, Email cnodongo@gmail.comBackground: The diagnosis of extrahepatic obstructive jaundice (EHOJ) remains a challenge and is often made late in low-resource settings. Systematic data are limited on the etiology and prognosis of patients with obstructive jaundice in Uganda. The objective of this study was to determine the etiology, clinical presentations, and short-term treatment outcomes of patients managed for EHOJ at Mbarara Regional Referral Hospital (MRRH) in south-western Uganda.Methods: Between September 2019 and May 2020, we prospectively enrolled a cohort of patients who presented with EHOJ at MRRH. A pretested, semi-structured data collection tool was used to abstract data from both the study participants and their files.Results: A total of 72 patients, 42 (58.3%) of whom were male with a median age of 56 (range of 2 months to 95 years) were studied. Forty-two (58.3%) participants had malignancies: Pancreatic head tumors 20 (27.8%), cholangiocarcinoma 13 (18.1%), duodenal cancers 5 (6.94%), and gall bladder cancer 4 (5.6%). The remaining 30 (41.7%) participants had benign etiologies: choledocholithiasis 10 (13.9%), biliary atresia 7 (9.7%), pancreatic pseudo cyst 6 (8.3%), Mirizzi syndrome 5 (6.9%) and 1 (1.4%) each of chronic pancreatitis and choledochal cyst. Sixty-seven (93.1%) patients presented with right upper quadrant tenderness, 65 (90.3%) abdominal pain and 55 (76.3%) clay-colored stool. Cholecystectomy 11 (25.6%) and cholecystojejunostomy + jejunojejunostomy 8 (18.6%) were the commonest procedures performed. Twelve (17.0%) of cases received chemotherapy (epirubicin/cisplatin/capecitabine) for pancreatic head tumors and (gemcitabine/oxaliplatine) for cholangiocarcinoma. Mortality rate was 29.2% in the study, of which malignancy carried the highest mortality 20 (95.24%).Conclusion: Malignancy was the main cause of EHOJ observed in more than half of the patients. Interventions aimed at early recognition and appropriate referral are key in this population to improve outcomes.Keywords: Uganda, malignant obstructive jaundice, benign obstructive jaundice

Purpose: To compare the survival prognosis of percutaneous transhepatic biliary stenting (PTBS) in the treatment of malignant obstructive jaundice (MOJ) at different horizontal sites. Methods: A total of 120 patients with MOJ who underwent biliary stenting were retrospectively included and analyzed and divided into the high-position group (36 patients), middle-position group (43 patients), and low-position group (41 patients) according to biliary obstruction plane by biliary anatomy. Kaplan–Meier curves were used to test for differences in the overall survival (OS), risk assessment of death and potential risk factors for 1-year survival were analyzed using multifactorial Cox regression. Results: The median survival of the high-, middle-, low-position groups were 16, 8.6, and 5.6 months, with a statistically significant difference (P = 0.017). The 1-year survival rate was 67.6%, 41.9%, and 41.5% in the high-, middle-, low-position groups (P < 0.05), and the 1-year risk of death was 2.35 and 2.93 times higher in the medium- and low-position groups, respectively. The incidences of the main complications were 25%, 48.8%, and 65.9% in the high-, middle-, and low-position groups, respectively, (P = 0.002). While the differences in median stent patency were not statistically significant (P > 0.05) in the groups, alanine transaminase, aspartate transaminase, and total bilirubin levels decreased gradually in each group at 1 month and 3 months after interventional therapy (P < 0.001), while there was no significant difference in the decrease between the groups. Conclusions: Different levels of biliary obstruction in patients with MOJ affect survival, especially at 1 year, where high obstruction treated with PTBS has a low incidence of complications and a low risk of death. [ABSTRACT FROM AUTHOR]

Objective　To explore the relationship between quantitative analysis of real-time ultrasound elastography and the prognosis of percutaneous transbiliary drainage ( PTCD) in elderly patients with advanced malignant obstructive jaundice. Methods　Retrospectively selected 112 elderly patients with advanced malignant obstructive jaundice who underwent PTCD treatment in our hospital between May 2017 and May 2021 were divided into poor prognosis (n = 42) and good prognosis groups (n = 70) according to their prognosis. We compared the clinical data of the two groups, the quantitative indexes of real-time ultrasound elastography before and after PTCD, analyzed the correlation between the quantitative indexes of real-time ultrasound elastography and Child-Pugh score, the quantitative indexes of real-time ultrasound elastography after PTCD and the prognosis of PTCD in elderly patients with advanced malignant obstructive jaundice, and drew the receiver operating characteristic (ROC) curve, and evaluated the value of real-time ultrasound elastography quantitative indicators for the prognosis of elderly patients with advanced malignant obstructive jaundice after PTCD. Results　There were statistically significant differences in the site of obstruction, Child-Pugh score, and total bilirubin level between the two groups ( P < 0.05). The mean value of strain of real-time postoperative ultrasound elastography quantitative index of PTCD in the poor prognosis group was lower than that in the good prognosis group, and the percentage of blue field was higher than that in the good prognosis group (P < 0.05). The mean value of strain and blue field percentage were associated with Child-Pugh score (P < 0.05). Strain mean value and blue field percentage were independent factors influencing PTCD prognosis in elderly patients with advanced malignant obstructive jaundice ( P < 0.05) .The AUC for the combined diagnosis of strain mean value and blue field percentage in elderly patients with advanced malignant obstructive jaundice for PTCD prognosis was 0.862. Conclusions　Real-time ultrasound elastography quantitative measurement of mean strain and percentage of blue area in elderly patients with advanced malignant obstructive jaundice are related to the liver function and prognosis. Real-time ultrasound elastography quantification after PTCD can help predict the prognosis of the disease. It is of great significance in clinical work. [ABSTRACT FROM AUTHOR]

To compare the safety and efficacy of endoscopic retrograde cholangiopancreatography (ERCP) and percutaneous transhepatic cholangial drainage (PTCD) in the treatment of malignant obstructive jaundice, a systematic review and meta-analysis of published studies was undertaken to assess the differences between the two procedures in terms of efficacy and safety. From November 2000 to November 2022, the Embase, PubMed, MEDLINE, and Cochrane databases were searched for randomized controlled trials (RCTs) on the treatment of malignant obstructive jaundice with ERCP or PTCD. Two investigators independently assessed the quality of the included studies and extracted the data. Six RCTs, including 407 patients, were included. The results of the meta-analysis showed that the overall technical success rate in the ERCP group was significantly lower than that in the PTCD group (Z=3.19, P=0.001, OR=0.31 (95% CI: 0.15-0.64)), but with a higher overall procedure-related complication incidence rate (Z=2.57, P=0.01, OR=0.55 (95% CI: 0.34-0.87)). The incidence of procedure-related pancreatitis in the ERCP group was higher than that in the PTCD group (Z=2.80, P=0.005, OR=5.29 (95% CI: 1.65-16.97)), and the differences were statistically significant. No significant difference was observed between the two groups when the clinical efficacy, postoperative cholangitis, and bleeding rate were compared. Both treatments for malignant obstructive jaundice were efficacious and safe. However, the PTCD group had a greater technique success rate and a lower incidence of postoperative pancreatitis. The present meta-analysis has been registered in PROSPERO. [ABSTRACT FROM AUTHOR]

The article presents our experience of observing two different approaches for endoscopic retrograde drainage in patients with malignant pathology of the pancreatobiliary zone, complicated by the bile duct obstruction. In one case, in case of dysfunction of the installed uncovered stent as a result of incrustation with bile salts and/or tumor invasion, stent-to-stent restenting was performed. In the second case, if it was impossible to pass the guidewire retrogradely beyond the area of the tumor narrowing, an alternative method was used – bringing it down by percutaneous transhepatic access towards the endoscope to install a retrograde stent delivery system along it using the "Rendezvous" method.

Objective To compare the efficacy of biliary 125I seed stent and bare metal stent in the treatment of Bismuth Corlette Ⅲ cholangiocarcinoma complicated with obstructive jaundice. Methods A total of 51 patients with malignant biliary obstruction caused by Bismuth Corlette Ⅲ cholangiocarcinoma who were treated in our department from January 2010 to June 2018 were systematically retrospectively collected, of whom 25 were in the 125I seed stent implantation group ( observation group). There were 26 cases in the bare metal stent implantation group (control group), and the preoperative and postoperative liver function, complication rate, stent patency time and survival time were compared between the two groups. Results The liver function and jaundice degree of patients in the 125I seed stent implantation group ( observation group) and bare metal stent implantation group ( control group) were significantly improved at 1 month after surgery. Compared with the control group, the observation group did not increase the incidence of postoperative complications. The average stent patency time in the observation group was (369.20±231.64) d, and the stent patency time was 310.05 d in the control group, the average stent patency time in the control group was (194.57±118.09) d, and the median stent patency time was 142.52 d. The stent patency time in the observation group was significantly longer than that in the control group (P＜0.05). The median survival period was (334.24 ± 193.38) d, and the median survival period was 385.21 d. The average survival period of the control group was (251.23 ± 182.51) d, and the median survival period was 274.43 d. The survival period of patients in the observation group was significantly longer than that in the control group (P＜0.05). Conclusion Compared with bare metal stent, biliary 125I seed stent can significantly reduce stent restenosis rate, prolong stent patency time, and improve patient survival without increasing postoperative complications. [ABSTRACT FROM AUTHOR]

Background: Malignant biliary obstructions, are mainly treated by endoscopic retrograde cholangio-pancreatography (ERCP); but, if ERCP fails, percutaneous transhepatic cholangiography (PTC) remain save approaches regardless of advancements of the recent ERCP technique. Rendezvous technique combines the radiological and endoscopic technique for palliative treatment in cases where the endoscopic techniques have failed. Methods: This study is a controlled study and was carried out upon (24) patients complaining of malignant biliary obstruction symptoms with failed cannulation by ERCP, between the period from January 2017 and January 2019 in the general surgery department of Zagazig University Hospitals.Results: The mean age of patients was 55.81± 15.13, range from 35-75. Most of them were males (66.7%). 41.7% of Malignant obstructive jaundice cases caused by pancreatic carcinoma, 33.3% caused by periampullary carcinoma and 25% of them caused by cholangiocarcinoma. Regarding the site of obstruction, more than half of them (62.5%) had distal site of obstruction and 37.5% of them had proximal site of obstruction. Concerning CT, 70% of the studied group had liver nodules and 30 % of them had liver nodules and malignant ascites. In addition to MRCP, all of the studied group (100%) had marked intra hepatic biliary radical dilatation, success rate of rendezvous technique was 91.7% .Conclusions: Percutaneous-transhepatic-endoscopic rendezvous procedures have high success rates (91.7%). If percutaneous procedure is necessary, RV techniques may approving safety than PTC, and have all the advantages of endoscopy. [ABSTRACT FROM AUTHOR]

Background The capacity and expertise for self-expanding percutaneous transhepatic metallic biliary stent (PTMBS) placement for palliative care in patients with malignant obstructive biliary diseases have recently been established at a private centre in Lagos, Nigeria. This article highlights the clinical and procedural aspects of the initial 18-month experience. Methods Between November 2018 and June 2020, PTMBS placement was performed on 16 patients. Data on patient demographics, chief complaints, primary diagnoses and diagnostic methods, concurrent procedures during stent placement, stent numbers, procedural complications, and postprocedural survival were collected and analysed. Results The cohort comprised 9 males and 7 females, with a mean age of 61 years. Presenting symptoms included eye and skin jaundice and pruritus, with Eastern Cooperative Oncology Group Performance Status scores of 0 for 2 patients, 1 for 9 patients, and 2 for 5 patients. Diagnoses included cholangiocarcinoma in 7 patients (44%) and pancreatic cancer in 5 (31%). All procedures were successful on the first attempt. Complications included 1 case each of intraoperative ileus, operative site infection, suspected cholangitis with sepsis, and death due to severe sepsis. Reintervention of the placed stent was necessary in 3 instances. Additional intraoperative procedures, such as brush biopsy and ultrasound-guided needle biopsy, were conducted for 7 patients. At the time of reporting, 5 patients (31%) remained alive at 22, 11, 8, 5, and 1 month(s) following the procedure. Conclusions This report validates the feasibility of advanced interventional radiology procedures like PTMBS placement in our region despite the inherent challenges. [ABSTRACT FROM AUTHOR]

Objective To observe the effect of predictive care in preventing complications after percutaneous transhepatic cholangial drainage (PTCD) in patients with malignant obstructive jaundice. Methods Eighty patients with malignant obstructive jaundice who underwent PTCD treatment were admitted to the Hepatobiliary and Pancreatic Center of Xuzhou Central Hospital from January 2018 to October 2019. They were randomly divided into 2 groups with 40 cases in each group: regular nursing group and the experimental group, the latter was implemented predictive nursing strategies on the basis of the former, then compared the anxiety(SAS) scores and depression (SDS) scores of the two groups before and after intervention, and observed the monitoring time, hospitalization time, nursing satisfaction and postoperative complications of the two groups. Results After the intervention, the SAS score and SDS score of the experimental group were significantly lower than those of the control group(P＜0.05); the monitoring time and hospitalization of the experimental group were significantly shorter than those of the control group (P＜0.05); the experimental group was generally satisfied with the nursing care. The rate was 100% and the control group was 97.5%. The total incidence of postoperative complications in the experimental group was 10%, which was significantly lower than the control group (30%) (P＜0.05). Conclusions Predictive care for patients with malignant obstructive jaundice who underwent PTCD therapy can effectively alleviate their anxiety and depression, reduce the risk of postoperative complications, and speed up recovery.

Objective: To investigate the related factors of early cholangitis after biliary drainage for malignant obstructive jaundice. Methods: The clinical data of patients with malignant obstructive jaundice, from January 2013 to July 2020, treated in Department of General Surgery, Ruijin Hospital North, Shanghai JiaoTong University School of Medicine were analyzed retrospectively. According to cholangitis in two weeks after biliary drainage, the patients were divided into two groups. The clinical characteristics were analyzed by SPSS 21.0. Results: A total of 69 patients were enrolled in this study, including 40 males and 29 females. 17 patients developed cholangitis within 2 weeks after biliary drainage, with a median infection time of 3 (2-11.5 days). There were no significant differences in age, gender, course of disease, total bilirubin and drainage mode between the two groups, but there were significant differences in the diameter of drainage and the location of biliary obstruction (P<0.05). Logistic regression analysis showed that the diameter of drainage was the related factor of early cholangitis after biliary drainage [OR=0.889, 95%CI (0.792, 0.998), P=0.046]. Conclusion: When malignant obstructive jaundice is treated by biliary drainage, large diameter drainage should be selected. It can reduce the occurrence of early cholangitis after biliary drainage for malignant obstructive jaundice by adequate and effective drainage of biliary. [ABSTRACT FROM AUTHOR]

Objective The model of 125 I seed strand simulating the radian of bile duct of the obstructive part in patients with malignant obstructive jaundice was constructed. The effect of the length and activity of !2!5 I seed strand on the terminal and central dose of the lesion was evaluated by treatment planning system ( TPS) . Methods Eighteen patients with malignant obstructive jaundice treated with bile duct stents combined with 125 I seed strand were collected. The water phantom was made by three-dimensional TPS. The water phantom was imported into radioactive seed source and then was implanted into DICOM format. The calculated radians of 18 patients were calculated according to the solution transcendental equation and then were converted into converted radians. The average value of 85°of converted radians of 18 patients was defined as the radian of the model, and the average value of 45 mm of bile duct obstruction length of 18 patients was defined as the length of model lesions. We drew a seed strand model with an an: of 85° and a length of 45 mm on the water model. The model 1 was composed of 10 seeds. We added 1, 2, 3 and 4 seeds at both ends of the seed strand to form models 2, 3, 4 and 5. We set the seed activity of the model to 0. 5, 0. 6, 0. 7, 0. 8, 0. 9 and 1. 0 mCi, and observed the dose difference of the lesion end and lesion center on the centripetal side and centrifugal side of the seed strand wider each model. Results In the same model, the cumulative doses of centripetal and centrifuge side of lesion end and lesion center increased with the increase of seed activity. Under the same seed activity, the cumulative doses at the end of the lesion, the centripetal side and the centrifugal side in the model 5 were greater than those in the other four models. Under the same particle activity and the same model, the cumulative dose on the centrifugal side at the end of the lesion was greater than that on the centripetal side, and the cumulative dose on the centrifugal side in the center of the lesion was less than that on the centripetal side. On the centripetal side, the cumulative dose differences of models 1, 2, 3, 4 and 5 under different particle activities were 74. 94%, 40. 92%, 26. 74%, 20. 82%, and 17. 90%, respectively. The cumulative dose differences decreased with the increase of the length of the model particle strip. On the centrifugal side, the maximum differences of models 1, 2, 3, 4 and5 were5.20%, -11. 38%, -16. 71%, -19.34% and-20.68%, respectively. The difference of cumulative dose increased with the increase of model particle strip length. Conclusions Based on the malignant obstructive jaundice model with the lesion length of 45 mm and the radian of 85°, when the biliary stent is located on the centripetal side of the seed strand, adding seeds at the end of the lesion can reduce the cumulative dose difference between the end and the center of the lesion; when the biliary stent is located on the centrifugal side of the seed strand, the difference is the lowest when the lesion length is equal to the length of the seed strand. [ABSTRACT FROM AUTHOR]

Background: Malignant obstructive jaundice (MOJ) is a condition characterized by varying degrees of bile duct stenosis and obstruction, accompanied by the progressive development of malignant tumors, leading to high morbidity and mortality rates. Currently, the two most commonly employed methods for its management are percutaneous transhepatic bile duct drainage (PTBD) and endoscopic ultrasound-guided biliary drainage (EUS-BD). While both methods have demonstrated favorable outcomes, additional research needs to be performed to determine their relative efficacy., Aim: To compare the therapeutic effectiveness of EUS-BD and PTBD in treating MOJ., Methods: This retrospective analysis, conducted between September 2015 and April 2023 at The Third Affiliated Hospital of Soochow University (The First People's Hospital of Changzhou), involved 68 patients with MOJ. The patients were divided into two groups on the basis of surgical procedure received: EUS-BD subgroup ( n = 33) and PTBD subgroup ( n = 35). Variables such as general data, preoperative and postoperative indices, blood routine, liver function indices, myocardial function indices, operative success rate, clinical effectiveness, and complication rate were analyzed and compared between the subgroups., Results: In the EUS-BD subgroup, hospital stay duration, bile drainage volume, effective catheter time, and clinical effectiveness rate were superior to those in the PTBD subgroup, although the differences were not statistically significant ( P > 0.05). The puncture time for the EUS-BD subgroup was shorter than that for the PTBD subgroup ( P < 0.05). Postoperative blood routine, liver function index, and myocardial function index in the EUS-BD subgroup were significantly lower than those in the PTBD subgroup ( P < 0.05). Additionally, the complication rate in the EUS-BD subgroup was lower than in the PTBD subgroup ( P < 0.05)., Conclusion: EUS-BD may reduce the number of punctures, improve liver and myocardial functions, alleviate traumatic stress, and decrease complication rates in MOJ treatment., Competing Interests: Conflict-of-interest statement: The authors declare no conflicts of interest in relation to this article., (©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.)

Background: Percutaneous transhepatic cholangiodrainage (PTCD) and endoscopic retrograde cholangiopancreatography/endoscopic nasobiliary drainage are the most common clinical procedures for jaundice control in patients with unresectable malignant obstructive jaundice, yet the safety and effect of endobiliary radiofrequency ablation (EB-RFA) combined PTCD is rarely reported, in this article, we report our experience of EB-RFA combined PTCD in such patients., Aim: To retrospectively study the efficacy and safety of EB-RFA combined PTCD in patients with unresectable malignant obstructive jaundice., Methods: Patients with unresectable malignant obstructive jaundice treated with EB-RFA under PTCD were selected, the bile ducts of the right posterior lobe was selected as the target bile ducts in all cases. The general conditions of all patients, preoperative tumour markers, total bilirubin (TBIL), direct bilirubin (DBIL), albumin (ALB), alkaline phosphatase (ALP), and glutamyl transferase (GGT) before and on the 7 th day after the procedure, as well as perioperative complications, stent patency time and patient survival were recorded., Results: All patients successfully completed the operation, TBIL and DBIL decreased significantly in all patients at the 7 th postoperative day ( P = 0.009 and 0.006, respectively); the values of ALB, ALP and GGT also decreased compared with the preoperative period, but the difference was not statistically significant. Perioperative biliary bleeding occurred in 2 patients, which was improved after transfusion of blood and other conservative treatments, pancreatitis appeared in 1 patient after the operation, no serious complication and death happened after operation. Except for 3 patients with loss of visits, the stent patency rate of the remaining 14 patients was 100% 71% and 29% at the 1 st , 3 rd , and 6 th postoperative months respectively, with a median survival of 4 months., Conclusion: EB-RFA under PTCD in patients with unresectable malignant obstructive jaundice has a satisfactory therapeutic effect and high safety, which is worthy of further clinical practice., Competing Interests: Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article., (©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.)

Cholangiocarcinoma (CCA) is a malignant hepatic tumor with a poor prognosis, which needs early diagnosis urgently. The gut microbiota has been shown to play a crucial role in the progression of liver cancer. Here, we explored a gut microbiota model covering genera Burkholderia-Caballeronia-Paraburkholderia , Faecalibacterium , and Ruminococcus_1 (B-F-R) for CCA early diagnosis. A case-control study was conducted to enroll 53 CCA patients, 47 cholelithiasis patients, and 40 healthy controls. The feces samples and clinical information of participants were collected in the same period. The gut microbiota and its diversity of individuals were accessed with 16S rDNA sequencing, and the gut microbiota profile was evaluated according to microbiota diversity. Finally, four enriched genera in the CCA group (genera Bacteroides , Muribaculaceae_unclassified , Muribaculum , and Alistipes) and eight enriched genera in the cholelithiasis group (genera Bifidobacterium , Streptococcus , Agathobacter , Ruminococcus_gnavus_group , Faecalibacterium , Subdoligranulum , Collinsella , Escherichia-Shigella) constitute an overall different microbial community composition (P = 0.001). The B-F-R genera model with better diagnostic value than carbohydrate antigen 19-9 (CA19-9) was identified by random forest and Statistical Analysis of Metagenomic Profiles (STAMP) to distinguish CCA patients from healthy controls [area under the curve (AUC) = 0.973, 95% CI = 0.932–1.0]. Moreover, the correlative analysis found that genera Burkholderia-Caballeronia-Paraburkholderia were positively correlated with body mass index (BMI). The significantly different microbiomes between cholelithiasis and CCA were found via principal coordinates analysis (PCoA) and linear discriminant analysis effect size (LEfSe), and Venn diagram and LEfSe were utilized to identify four genera by comparing microbial compositions among patients with malignant obstructive jaundice (MOJ-Y) or not (MOJ-N). In brief, our findings suggest that gut microbiota vary from benign and malignant hepatobiliary diseases to healthy people and provide evidence supporting gut microbiota to be a non-invasive biomarker for the early diagnosis of CCA. [ABSTRACT FROM AUTHOR]

Cholangiocarcinoma (CCA) is a malignant hepatic tumor with a poor prognosis, which needs early diagnosis urgently. The gut microbiota has been shown to play a crucial role in the progression of liver cancer. Here, we explored a gut microbiota model covering genera Burkholderia-Caballeronia-Paraburkholderia, Faecalibacterium, and Ruminococcus_1 (B-F-R) for CCA early diagnosis. A case-control study was conducted to enroll 53 CCA patients, 47 cholelithiasis patients, and 40 healthy controls. The feces samples and clinical information of participants were collected in the same period. The gut microbiota and its diversity of individuals were accessed with 16S rDNA sequencing, and the gut microbiota profile was evaluated according to microbiota diversity. Finally, four enriched genera in the CCA group (genera Bacteroides, Muribaculaceae_unclassified, Muribaculum, and Alistipes) and eight enriched genera in the cholelithiasis group (genera Bifidobacterium, Streptococcus, Agathobacter, Ruminococcus_gnavus_group, Faecalibacterium, Subdoligranulum, Collinsella, Escherichia-Shigella) constitute an overall different microbial community composition (P = 0.001). The B-F-R genera model with better diagnostic value than carbohydrate antigen 19-9 (CA19-9) was identified by random forest and Statistical Analysis of Metagenomic Profiles (STAMP) to distinguish CCA patients from healthy controls [area under the curve (AUC) = 0.973, 95% CI = 0.932–1.0]. Moreover, the correlative analysis found that genera Burkholderia-Caballeronia-Paraburkholderia were positively correlated with body mass index (BMI). The significantly different microbiomes between cholelithiasis and CCA were found via principal coordinates analysis (PCoA) and linear discriminant analysis effect size (LEfSe), and Venn diagram and LEfSe were utilized to identify four genera by comparing microbial compositions among patients with malignant obstructive jaundice (MOJ-Y) or not (MOJ-N). In brief, our findings suggest that gut microbiota vary from benign and malignant hepatobiliary diseases to healthy people and provide evidence supporting gut microbiota to be a non-invasive biomarker for the early diagnosis of CCA.

Background: Magnetic resonance cholangiopancreatography (MRCP) and percutaneous trans-hepatic cholangiography (PTC) are established techniques for the evaluation of intra-hepatic and extra-hepatic bile ducts in patients with malignant hepato-biliary diseases. PTC has procedure-related complications. MRCP is accurate, noninvasive and safe. Objective: To evaluate the role of magnetic resonance cholangiopancreatography (MRCP) and percutaneous transhepatic cholangiography (PTC) in the diagnosis of malignant biliary obstruction. Patients and Methods: This study was conducted on 30 patients (18 males and 12 females) with malignant obstructive jaundice. Their ages ranged between 36 and 85 years with a mean age of 59.9 years. All the 30 examined cases in our study were subjected to MRCP and PTC to detect the diagnosis, the level of obstruction and the degree of obstruction. Results: Both MRCP and PTC were accurate in the detection of the malignant biliary dilatation and the level of obstruction. MRCP provided adequate information in the diagnosis of the malignant lesions with sensitivity of 86.6% with low sensitivity to detect the degree of obstruction weather complete or partial 12.5% compared to PTC. MRCP detected other related malignant features in 40% of cases. PTC-related complications in 6 out of 30 cases (20%). In 6 patients more than one puncture had to be performed during PTC to delineate the whole biliary system. Conclusion: MRCP is accurate and non-invasive procedure for the diagnosis of the malignant obstructive jaundice and the level of biliary obstruction reserving PTC for therapeutic procedures and pre-surgical assessment of the degree of obstruction. [ABSTRACT FROM AUTHOR]

Objective Based on nutritional risk assessment-2002 (NRS-2002)and inflammatory markers, the Nomogram model was established to predict the prognosis of patients with malignant obstructive jaundice (MOJ). Methods Totally 129 patients with MOJ were treated with biliary stent implantation combined with percutaneous transhepatic biliary drainage. NRS-2002, neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR)and other data of patients were collected. The situations of patients were observed, and the best cut-off value of continuous clinical data[age, body mass index (BMI), total bilirubin (TBIL), direct bilirubin (DBIL), total cholesterol (TC), albumin (ALB), hemoglobin (HB), NLR, and PLR]was obtained by receiver operating characteristic (ROC)curve to diagnose the death of patients with MOJ. Univariate and multivariate Cox proportional risk models were used to analyze the independent risk factors for death in MOJ patients. According to the independent risk factors, Nomogram model was constructed, and external data were used for the effectiveness verification. Results Totally 129 patients with MOJ were followed up, and the survival time was 32-351 (184. 71±26. 74)d. Twenty patients with MOJ survived, 109 patients with MOJ died, and the mortality was 84. 5%. The age, BMI, TBIL, DBIL, TC, ALB, Hb, NLR and PLR were analysed by Roc. The area under the curve (AUC)of age, BMI, TBIL, DBIL, TC, ALB, Hb, NLR and PLR were 0. 652, 0. 637, 0. 549, 0. 531, 0. 596, 0. 727, 0. 586, 0. 744 and 0. 735 respectively. The best cut-off values were 65 years old, 19. 4kg/m2, 172. 7 umol/L, 138. 2 umol/L, 4. 13 mmol/L, 38. 6 g/L, 85 g/L, 2. 52 and 0. 52, respectively. Among 129 patients with MOJ, there were 14 patients with normal nutrition, 86 patients with malnutrition risk and 29 patients with malnutrition. The proportion of ALB (≤ 38. 6 g/L), NLR (> 2. 52), PLR (> 0. 52)and malnutrition in the dead patients were higher than those in the survival patients (all P <0. 05), while the proportion of normal nutrition was lower than that in the survival patients (P <0. 05). Multivariate Cox proportional hazard model analysis showed that NLR (HR: 1. 718, 95%CI: 1. 119-2. 637), PLR (HR: 1. 699, 95%CI: 1. 042-2. 711), NRS-2002[malnutrition risk (HR: 3. 204, 95%CI: 1. 339-6. 368), malnutrition (HR: 7. 416, 95%CI: 1. 231-9. 525)]were independent risk factors for death in MOJ patients (all P <0. 05). The external validation results of nomogram model showed that the survival C-index of 90, 180 and 270 d was 0. 756 (95%CI: 0. 695-0. 862), 0. 701 (95%CI: 0. 647-0. 781)and 0. 698 (95%CI: 0. 611-0. 778), respectively. Conclusion Based on NRS-2002 combined with inflammatory markers, Nomogram model is successfully constructed to predict the prognosis of patients with MOJ. [ABSTRACT FROM AUTHOR]

Objective　To explore the changing characteristics of fecal bacteria in patients with malignant obstructive jaundice. Methods　From January 2019 to May 2019，87 cases with malignant obstructive jaundice were taken as case bank and screened by inclusion and exclusion criteria. After that，10 patients and 10 healthy relatives of patients were selected， age， sex and BMI were recorded， and faeces were sent for 16srDNA copy number. Results （1）The fecal bacteria abundance and diversity index of the experimental group were lower than that of the control group， but there was no statistical significance （P < 0.05）. However， when the data of fecal bacteria abundance were presented in the Heatmap， the intuitive difference was more obvious. （2） The data of the two groups were subdivided by bacteria genus， and it was found that the composition of fecal bacteria genus in the experimental group changed fundamentally compared with that in the control group （ P < 0.05） . Among them， Escherichia-Shigella，Streptococcus，Veillonella，Enterococcus，Akkermansia increased significantly， while the bacteria genera of wiesia and clostridium declined significantly. Whether the intestinal flora can be rebalanced may affect the therapeutic effect. Conclusion　The fecal flora structure of patients with malignant obstructive jaundice is significantly different from that of normal control group， and the dominant flora genus has been fundamentally changed. [ABSTRACT FROM AUTHOR]

To explore and analysis the factors of complications after biliary stent implantation in the treatment of malignant obstructive jaundice. From October 2015 to October 2019, Used retrospective research methods, 112 cases of patients with malignant obstructive jaundice who were diagnosed and treated in the Intensive Care Unit (ICU) of our hospital were selected as the research objects. All patients were given biliary tract stent implantation treatment, recorded postoperative infection complications. Investigated the clinical data of patients and analyzed the influencing factors. There were 18 cases of postoperative infection complications in the 112 patients that the incidence rate were 16.1 %, included 5 cases of biliary tract infection, 4 cases of lung infection, and 9 cases of incision infection. The postoperative 7 d of serum IL-6, TNF-α, AST, and ALT values of 112 patients were lower than that of preoperative, and the ratio of CD4+ cells were higher than that of preoperative (P<0.05). The ratio of CD8+ cells were in the operation ere no statistically significant difference compared between before and after surgery (P>0.05). Pearson analysis showed that postoperative infection were correlated with APACHEⅡ score, hospital stay, diabetes, smoking, preoperative IL-6 value and preoperative CD4+ cell ratio (P<0.05). Logistic regression analysis showed that APACHEⅡ score, length of stay, diabetes, smoking, preoperative IL-6 value, preoperative CD4+ cell ratio were the main influence factors of postoperative infection in patients (P<0. 05). Biliary stent implantation in the treatment of malignant obstructive jaundice can inhibit the release of inflammatory factors, promote the recovery of the patient's immune function, and improve the patient's liver function, but it is accompanied by the occurrence of infection complications, APACHE Ⅱ score, hospital stay, diabetes, smoking, The preoperative IL-6 value and the preoperative CD4+ cell ratio are the main factors affect the incidence of postoperative infection in patients. [ABSTRACT FROM AUTHOR]

Lung cancer metastases to the pancreas are rare but potentially life-threatening. Oftentimes, the presence of symptoms is indicative of extensive disease burden. This report describes a case of primary lung adenocarcinoma metastasizing to the head of the pancreas presenting as obstructive jaundice. The patient was a 61-year-old female veteran who presented with a chronic dyspnea, weight loss, and 3-weeks of nausea and vomiting found to have jaundice, elevated alkaline phosphatase levels, hyperbilirubinemia, and transaminitis. Imaging of her chest revealed large pulmonary parenchymal nodules throughout both lungs with a large left lower lobe mass and consolidation. Abdominal imaging showed a large heterogeneous mass in the pancreatic head, a grossly dilated common bile duct, and enlarged retroperitoneal lymph nodes contiguous with the mass. Pancreatic head biopsies revealed metastatic cancer cells from her lung adenocarcinoma which was confirmed via cytology and the presence of thyroid transcription factor − 1 and cytokeritin-7 expression and the absence of tumor protein 63 staining. Lung adenocarcinomas commonly metastasize to the bones, liver, and central nervous system but very rarely to the pancreas. There have been only a few reported cases of pancreatic tumors that manifested clinically as a result of primary lung cancer metastases however, even though uncommon, hematogenous spread of cancerous tissue should be considered on the differential as a cause for obstructive jaundice in the setting of lung adenocarcinoma.

Background/Aim: Malignant obstructive jaundice (MOJ) is a common condition caused by several primary and secondary cancers. We performed a systematic review and meta-analysis to investigate technical success rate and safety of percutaneous transhepatic biliary drainage (PTBD) versus endoscopic biliary drainage (EBD) in MOJ. Materials and Methods: Relevant trials were identified by searching electronic databases and conference meetings. We included thirteen retrospective studies and four randomized controlled trials, with PTBD performed in 2353 patients and EBD in 8178 patients. Outcomes of interest included: technical success rate, overall complications, 30-day mortality rate and risk of bleeding, pancreatitis, cholangitis and tube dislocation. Results: The differences in technical success rate, total complications, 30-day mortality rate and tube dislocation were not statistically significant between the two groups. Patients receiving PTBD showed a lower risk of pancreatitis (OR=0.14, 95%CI=0.06-0.31) and cholangitis (OR=0.52, 95%CI=0.30-0.90) when compared to EBD while PTBD was associated with higher risk of bleeding (OR=1.78; 95%CI=1.32-2.39). Conclusion: Our metaanalysis indicates the presence of some advantages and limits for both PTBD and EBD. We highlight the paucity of quality-of-life data, a vital element which should be carefully pondered in future studies and in choosing the optimal technique in patients with MOJ. [ABSTRACT FROM AUTHOR]

Background: This study aimed to compare the treatment outcomes and safety between stent placement with or without Iodine-125 (125I) seeds strand for patients with unresectable malignant obstructive jaundice (MOJ). Methods: A total of 84 patients with unresectable MOJ treated in our hospital were retrospectively included and divided into the stent group (n = 54) undergoing biliary stent placement and the stent + seeds group (n = 30) receiving stent placement with 125I seeds strand. The therapeutic outcome, postoperative complications, duration of patient survival and stent patency were compared between groups. Kaplan–Meier survival analysis was performed to compare the duration of patient survival and stent patency between groups. Cox-regression analysis was performed to investigate predictive factors for disease-free survival and overall survival. Results: The stent + seeds group had significantly longer duration of patency (231.57 ± 256.54 vs. 110.37 ± 120.52) and overall survival (310.57 ± 330.54 vs. 173.15 ± 219.40) than the stent group (both p <.05). In addition, Kaplan–Meier survival analysis confirmed that the stent + seeds group had longer duration of patency (log-rank test, p =.001) and higher overall survival rate (log-rank test, p =.020) than the stent group. Furthermore, Cox-regression analysis demonstrated that treatment methods was an independent factor associated with disease-free survival (HR: 0.36, 95% CI: 0.19–0.70; p =.003) and overall survival (HR: 1.01, 95% CI: 1.00–1.01; p <.001). Conclusion: The stent placement with 125I seeds strand can significantly improve the primary patency rate and overall survival time in MOJ patients. [ABSTRACT FROM AUTHOR]

Abstract Background Malignant obstructive jaundice is a common problem in the clinic. Currently, the generally applied treatment methods are percutaneous transhepatic biliary drainage (PTBD) and endoscopic biliary drainage (EBD). Nevertheless, there has not been a uniform conclusion published on either efficacy of the two types of drainage or the incidence rate of complications. Therefore, we conducted a systematic review and meta-analysis of studies comparing endoscopic versus percutaneous biliary drainage in malignant obstructive jaundice, to determine whether there is any difference between percutaneous and endoscopic biliary drainage, with respect to efficacy and incidence rate of overall complications. Methods The enrolled studies contain a total of three randomized controlled trials and eleven retrospective studies, which together encompass 2246 patients with PTBD and 8100 patients with EBD. Results Our analysis indicates that there is no difference between PTBD and EBD with regard to therapeutic success rate (%), overall complication (%), intraperitoneal bile leak, 30-day mortality, sepsis, or duodenal perforation (%). Cholangitis and pancreatitis after PTBD were lower than after EBD, with odds ratios (OR) of 0.48 (95% confidence interval (CI), 0.31 to 0.74) and 0.16 (95% CI, 0.05 to 0.52), respectively. Incidences of bleeding and tube dislocation for PTBD were higher than EBD, OR of 1.81 (95% CI, 1.35 to 2.44) and 3.41 (95% CI, 1.10 to 10.60). Conclusions This meta-analysis indicates certain advantages for both PTBD and EBD. In the clinical practice, it is advised to choose specifically either PTBD or EBD, based on location of obstruction, purpose of drainage (as a preoperative procedure or a palliative treatment) and level of experience in biliary drainage at individual treatment centers.

Aim: to obtain survival rate and mortality-related factors of malignant obstructive jaundice patients. Methods: all medical records of obstructive jaundice inpatient at Cipto Mangunkusumo Hospital, Jakarta from January 2010 to December 2013 were reviewed retrospectively. The following factors were analyzed in terms of mortality: age, gender, sepsis, hypoalbumin, serum bilirubin level, serum CA 19-9 level, billiary drainage, non-ampulla Vateri carcinoma, and comorbid factors. Results: total 181 out of 402 patients were enrolled in this study with male proportion was 58.6%, and patients aged 50 years or above was 57.5%. Multivariate analysis showed that only sepsis, unsuccessful or no prior biliary drainage and Charlson comorbid score ≥4 were independent predictors of mortality. Patients with significant prognostic factors had median survival 14 days compared with overall median survival 26 days. Score ≥2 identified as the highest prognostic score threshold with sensitivity 68%, specificity 75%, and AUC on ROC curve 0.769. Conclusion: sepsis, unsuccessful or no prior bilirary drainage, and Charlson comorbid score ≥4 are factors significantly associated with shortened survival in malignant obstructive jaundice patients. Prognostic score ≥2 was determined to classify patients into high risk mortality group. Mortality of patients with those significant prognostic factors can be predicted in 76.9%.

Introduction: Obstructive Jaundice resulting from various benign and malignant conditions of gastrointestinal tract may lead to variable increase in serum Carbohydrate Antigen (CA19-9), C Reactive Protein (CRP) and serum bilirubin level. Aim: To investigate the diagnostic utility of CA19-9, CRP, serum bilirubin level and their ratios, CA19-9/total bilirubin ratio and CA19-9/CRP, ratio in differentiating malignant obstructive jaundice from benign obstructive jaundice. Materials and Methods: This case control study considered 75 diagnosed cases of obstructive jaundice which were further divided into two sub-categories; Group I consisted of 36 patients with malignant obstructive jaundice and Group II consisted of 39 patients with benign obstructive jaundice. All patients were subjected to laboratory investigations which included CA 19-9, CRP and Total bilirubin. Median and interquartile range was used in descriptive statistics, as the data was not following normal distribution. The different groups were analysed using non parametric test and ROC used for predictive analysis. The results were statistically analysed using statistical software, R version 3.4.0. Results: A significant increase in serum CA 19-9, serum bilirubin and CRP was observed in malignant obstructive jaundice compared to benign obstructive jaundice. As per ROC analysis CA19-9 alone has the highest sensitivity value of 91.67, at a cut-off point of 410 U/mL whereas CRP reported the lowest in both sensitivity and specificity. However, when a ratio of CRP i.e., (CA19-9/CRP) is taken, the sensitivity value of 83.33 is obtained at a cut-off point of 40.56 and area under ROC is also significant, but there is decrease in both sensitivity and specificity when the ratio of bilirubin i.e., CA19-9/Bilirubin is considered. A logistic regression analysis found total bilirubin to be the most significant independent factor having an impact on malignancy. Conclusion: CA19-9, at a cut-off value of 410, has better sensitivity in differentiating malignant from benign obstructive jaundice compared to the ratio with CRP and total bilirubin. One of the major finding of the study is when CRP is adjusted for CA 19-9 i.e., CA19-9/CRP ratio proves to be a better marker, that can be used along with CA 19-9 in differentiating between malignant and benign obstructive jaundice.

Purpose: Malignant biliary obstruction (MBO) is common in patients with advanced malignant tumors, leading to poor prognosis and hindering antitumor therapy. The purpose of our study was to assess the survival outcomes for patients under therapy after percutaneous transhepatic biliary drainage (PTBD) and identify prognostic factors associated with survival in patients with MBO., Methods: From July 2010 to February 2021, 269 patients with MBO secondary to malignant tumor were divided into two groups (functional success and non-functional success). Survival time and prognostic factors were analyzed by Kaplan-Meier curves and the Cox model., Results: The overall median survival time after PTBD was 4.6 months (95 % IC:3.9-5.3). The 3- and 6-month survival rates were 68.0 % and 38.7 %, respectively. The median survival improved from 3.2 months to 8.4 months when the procedure achieved functional success. Multivariate analysis demonstrated that functionally successful drainage and antitumor treatment after PTBD were independent positive prognostic factors, but the total bilirubin after drainage and tumor size were independent negative predictive values., Conclusions: Functionally successful drainage could prolong survival time in patients with malignant biliary obstruction. Palliative care after drainage can prolong patient survival and improve their quality of life., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2024 The Authors.)

Purpose: To evaluate the effectiveness and safety of simultaneous placement of a self-expandable metallic stents (SEMS) and iodine-125 seed strand in the management of malignant obstructive jaundice (MOJ).Materials and Methods: This study included 132 patients with MOJ treated from November 2015 to October 2017. Forty-five patients underwent insertion of SEMS with iodine-125 seed strands (Seeds group); the remaining 87 patients underwent SEMS placement alone (Control group). Technical success was defined as accurate, successful deployment of SEMS with or without iodine-125 seed strand; clinical success was defined as 20% reduction in serum bilirubin within 1 week after the procedure, compared with baseline. Complications, duration of primary stent patency, and overall survival were evaluated.Results: Technical success was achieved in all patients in both groups. In the Seeds group, an average of 14 seeds (range 8-22) were implanted in the bile duct as a strand. Clinical success rates were similar between the groups (Seeds group, 93.3%; Control group, 95.4%). Major complications occurred in only one patient, in the Control group. The median period of primary stent patency was significantly longer in the Seeds group (194 days) than in the Control group (86 days; P = 0.049). The median overall survival was also significantly longer in the Seeds group (194 days) than in the Control group (96 days; P = 0.031).Conclusion: SEMS combined with iodine-125 seed strands is effective and safe in the management of MOJ and can improve stent patency and patient survival. [ABSTRACT FROM AUTHOR]

Introduction: Obstructive Jaundice resulting from various benign and malignant conditions of gastrointestinal tract may lead to variable increase in serum Carbohydrate Antigen (CA19-9), C Reactive Protein (CRP) and serum bilirubin level. Aim: To investigate the diagnostic utility of CA19-9, CRP, serum bilirubin level and their ratios, CA19-9/total bilirubin ratio and CA19-9/CRP, ratio in differentiating malignant obstructive jaundice from benign obstructive jaundice. Materials and Methods: This case control study considered 75 diagnosed cases of obstructive jaundice which were further divided into two sub-categories; Group I consisted of 36 patients with malignant obstructive jaundice and Group II consisted of 39 patients with benign obstructive jaundice. All patients were subjected to laboratory investigations which included CA 19-9, CRP and Total bilirubin. Median and interquartile range was used in descriptive statistics, as the data was not following normal distribution. The different groups were analysed using non parametric test and ROC used for predictive analysis. The results were statistically analysed using statistical software, R version 3.4.0. Results: A significant increase in serum CA 19-9, serum bilirubin and CRP was observed in malignant obstructive jaundice compared to benign obstructive jaundice. As per ROC analysis CA19-9 alone has the highest sensitivity value of 91.67, at a cut-off point of 410 U/mL whereas CRP reported the lowest in both sensitivity and specificity. However, when a ratio of CRP i.e., (CA19-9/CRP) is taken, the sensitivity value of 83.33 is obtained at a cut-off point of 40.56 and area under ROC is also significant, but there is decrease in both sensitivity and specificity when the ratio of bilirubin i.e., CA19-9/Bilirubin is considered. A logistic regression analysis found total bilirubin to be the most significant independent factor having an impact on malignancy. Conclusion: CA19-9, at a cut-off value of 410, has better sensitivity in differentiating malignant from benign obstructive jaundice compared to the ratio with CRP and total bilirubin. One of the major finding of the study is when CRP is adjusted for CA 19-9 i.e., CA19-9/CRP ratio proves to be a better marker, that can be used along with CA 19-9 in differentiating between malignant and benign obstructive jaundice. [ABSTRACT FROM AUTHOR]

Purpose The purpose of this study was to analyze the long-term outcomes, including safety, efficacy, and prognostic features, of intraluminal brachytherapy with Iodine-125 ( 125 I) seed strand and stent placement for treatment of patients with malignant obstructive jaundice (MOJ). Methods and Materials From January 2009 to December 2013, 107 consecutive patients with MOJ were treated with intraluminal placement of 125 I seed strands and metal stents. A retrospective evaluation of therapeutic outcomes, including overall survival (OS), stent patency rate, complications, and prognostic features, was conducted in 101 patients. Results 125 I seed strands and stents were all successfully implanted. The median followup time was 231 (45–1015) days, and the median OS was 394.0 (95% confidence interval: 319.1–468.9) days. The cumulative OS rates at 3, 6, 12, and 24 months were 95%, 77%, 53%, and 20%, respectively. The median stent patency period was 278.0 (95% confidence interval: 164.1–391.9) days, and cumulative patency rates at 3, 6, 12, and 24 months were 92%, 69%, 45%, and 13%, respectively. Multivariate analysis indicated that the serum conjugated/total bilirubin ≥88% before procedure ( p = 0.032) and whether the patient receiving further treatment ( p = 0.041) appear to be the prognostic factors of OS. There is no statistical prognostic factor for stent patency. Conclusions The intraluminal placement of 125 I seed strands and stents appears to be a safe and efficient therapy on MOJ. The patient with serum conjugated/total bilirubin ≥88% before procedure and receiving further treatment seems to live longer. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To evaluate the correlation between the change of immune system function before and after the treatment of malignant obstructive type jaundice (MOJ) treated with a biliary stent. PATIENTS AND METHODS: 148 patients who were admitted to the Department of Digestive System for malignant obstructive jaundice were selected according to the standardized criterion. Amongst the total sample size, 78 were male patients and 70 were female patients, with an average age of (43.6 ± 5.5) years. After admission, the patients completed the blood routine examination and received biliary stent treatment to relieve the sign and symptoms of jaundice. Follow- up observation included total white blood cells, CD4+T cell count, CD8+T cell count, the ratio of CD4+/CD8, neutrophil counts neutrophils percentage, total bilirubin, free bilirubin, alanine aminotransferase (ALT), and inflammatory factors. RESULTS: After three weeks of follow-up visit, CD4+T lymphocyte absolute value of patients markedly increased compared with that of pre-operation, and the difference had statistical significance (p < 0.05). The total bilirubin, free bilirubin, ALT, and inflammatory factors, such as hs-CRP, TNF-α in plasma of patients was significantly lower than that before the operation and the difference was statistically significant (p < 0.05). After six weeks of follow-up visit, the ratio of CD4+/CD8+ increased and the difference had statistical significance (p < 0.05) compared with that before biliary stent implantation. However, the white blood cell and neutrophil granulocyte did not improve significantly. It was found that CD4+/CD8+T lymphocyte had relation with the level of hs-CRP. CONCLUSIONS: The patients with the (MOJ) treated with implanted biliary stent revealed relive in the obstruction of biliary the tract, which will further significantly improve the cholestasis. The ratio of CD4+/CD8+T lymphocyte increased, which will improve the immune system system function of the patients, decreases the possibility of infection, and improves the overall survival quality. [ABSTRACT FROM AUTHOR]

Objectives: To evaluate therapeutic outcomes of intraluminal brachytherapy (ILBT) for malignant obstructive jaundice (MOJ) against stent alone.Methods: The PubMed, EMBASE, Cochrane Library, CNKI, Wan Fang, VIP and ClinicalTrials.gov databases were searched for all relevant comparative studies from the earliest available date up to 1 May 2017. Subgroup analyses were performed according to the type of study design and type of stent.Results: Twelve studies that compared ILBT versus stent alone were eligible. A total of 641 participants with MOJ were included in our meta-analysis. A total of 340 participants were treated with intraluminal brachytherapy (ILBT); the other 301 participants were treated with biliary stent alone (stent group). ILBT was associated with lower risk of stent occlusion (OR 0.19; 95% CI 0.13-0.28; P < 0.00001) and better mean survival (MD = 3.15; 95% CI 2.64-3.66; P < 0.00001) compared with stent alone. However, the two groups were similar in number of complications (OR 0.84; 95% CI 0.45-1.56; P = 0.578), post-treatment reduced level of total bilirubin (TBIL) (MD = 22.71; 95% CI - 7.24-52.65; P = 0.14), post-treatment reduced level of direct bilirubin (DBIL) (MD = - 3.67; 95% CI - 14.09-6.75; P = 0.49), post-treatment reduced level of alanine aminotransferase (ALT) (MD = 21.09; 95% CI - 5.09-47.28; P = 0.11) and post-treatment reduced level of aspartate aminotransferase (AST) (MD = 20.86; 95% CI - 45.86-87.58; P = 0.54).Conclusions: ILBT was significantly superior to stent alone in terms of stent occlusion and mean survival. Meanwhile, ILBT had comparable outcomes to stent alone in terms of complications and post-treatment reduced levels of TBIL, DBIL, ALT and AST. Therefore, ILBT may be considered a preferable technique for MOJ. [ABSTRACT FROM AUTHOR]