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Mirizzi syndrome is a complication of gallstone disease caused by an impacted gallstone in the infundibulum of the gallbladder or within the cystic duct, causing chronic inflammation and extrinsic compression of the common hepatic duct or common bile duct. Eventually, mucosal ulceration occurs and progresses to cholecystobiliary fistulation. Numerous systems exist to classify Mirizzi syndrome, with the Csendes classification widely adopted. It describes five types of Mirizzi syndrome according to the presence of a cholecystobiliary fistula and its corresponding severity, and whether a cholecystoenteric fistula is present. The clinical presentation of Mirizzi syndrome is non-specific, and patients typically have a longstanding history of gallstones. It commonly presents with obstructive jaundice, and can mimic gallbladder, biliary, or pancreatic malignancy. Achieving a preoperative diagnosis guides surgical planning and improves treatment outcomes. However, a significant proportion of cases of Mirizzi syndrome are diagnosed intraoperatively, and the presence of dense adhesions and distorted anatomy at Calot's triangle increases the risk of bile duct injury. Cholecystectomy remains the mainstay of treatment for Mirizzi syndrome, and laparoscopic cholecystectomy is increasingly becoming a viable option, especially for less severe stages of cholecystobiliary fistula. Subtotal cholecystectomy is feasible if total cholecystectomy cannot be performed safely. Additional procedures may be required, such as common bile duct exploration, choledochoplasty, and bilioenteric anastomosis. Conclusions: There is currently no consensus for the management of Mirizzi syndrome, as the management options depend on the extent of surgical pathology and availability of surgical expertise. Multidisciplinary collaboration is important to achieve diagnostic accuracy and guide treatment planning to ensure good clinical outcomes. [ABSTRACT FROM AUTHOR]

Aims: This study seeks to evaluate the association between pre‐transplant portal vein thrombosis (PVT) and overall survival, graft failure, waitlist mortality, and post‐operative PVT after liver transplantation. Methods: A conventional pairwise meta‐analysis between patients with and without pre‐transplant PVT was conducted using hazard ratios or odds ratios where appropriate. Results: Prevalence of preoperative PVT was 11.6% (CI 9.70–13.7%). Pre‐operative PVT was associated with increased overall mortality (HR 1.45, 95% CI 1.27–1.65) and graft loss (HR 1.58, 95% CI 1.34–1.85). In particular, grade 3 (HR 1.59, 95% CI 1.00–2.51) and 4 (HR 2.24, 95% CI 1.45–3.45) PVT significantly increased mortality, but not grade 1 or 2 PVT. Patients with PVT receiving living donor (HR 1.54, 95% CI 1.24–1.91) and deceased donor (HR 1.52, 95% CI 1.21–1.92) liver transplantation had increased mortality, with no significant difference between transplant types (P =.13). Furthermore, pre‐transplant PVT was associated with higher occurrence of post‐transplant PVT (OR 5.06, 95% CI 3.89–6.57). Waitlist mortality was not significantly increased in patients with pre‐transplant PVT. Conclusion: Graft failure, mortality, and post‐operative PVT are more common in pre‐transplant PVT patients, especially in grade 3 or 4 PVT. Prophylactic anticoagulation can be considered to reduce re‐thrombosis and improve survival. [ABSTRACT FROM AUTHOR]

Background: Colonoscopy requires the intubation of the cecum for screening of colorectal diseases. The conventional position used for colonoscopy is the left lateral position (LLP). However, alternative positions have also been utilized to enhance the success of intubation. Thus, the aim of this study was to perform a meta-analysis of the different positions to determine the effectiveness of the individual positions for successful colonoscopy., Methods: Medline, Embase and Cochrane trials electronic databases were searched for studies on colonoscopy positions. The primary outcome was defined as the cecal intubation rate. Pooled risk ratios (RR) and 95% confidence intervals (CI) for the rates of cecal intubation were estimated. Secondary outcomes such as the cecal intubation time and adenoma detection rate were further analyzed qualitatively., Results: After reviewing 644 identified records, 7 randomized control trials (RCT) studies were included. No significant difference was observed in either comparisons, between the LLP vs. supine position (SP) (RR = 1.01, 95% CI, 0.98 to 1.04, P  = 0.55) or the LLP vs. prone position (PP) (RR = 1.02, 95% CI, 0.98 to 1.06, P  = 0.27)., Conclusions: Amidst available literature, the use of other positions can be considered when performing colonoscopy. These further highlights that the existential practice is based predominantly on familiarity instead of evidence-based-research., Competing Interests: None., (© 2020 Chinese Medical Association. Publishing services by Elsevier B.V. on behalf of KeAi Communications Co. Ltd.)