Peer review report 1 on “Detection of benign hilar bile duct stenoses – A retrospective analysis in 250 patients with suspicion of Klatskin tumour”

Background. Radiofrequency ablation (RFA) is a palliative method known for its application in the endoscopic treatment of malignant bile duct obstruction. It may be a useful rescue method for metal stent malfunction caused by tumor ingrowth. This study aimed to examine the feasibility and safety of endoluminal RFA for occluded bilateral hilar metal stents due to tumor ingrowth in patients with malignant hilar bile duct obstruction. Methods: From March 2016 to June 2018, 11 patients with unresectable malignant hilar bile duct stricture with occluded bilateral hilar metal stents due to tumor ingrowth were enrolled. Endoluminal RFA was performed through a novel temperature-controlled catheter at a setting of 7 W power for 120 s with a target temperature of 80 °C via endoscopic retrograde cholangiopancreatography (ERCP). The patients’ demographics, clinical outcomes, and adverse events were investigated. Results: The median age was 64 (interquartile range, 54–72) years. All RFA procedures were successful. Clinical success was achieved in eight patients (72.7%). During the follow-up, eight patients (72.7%) showed stent dysfunction, and the median patency after RFA was 50 days (95% confidence interval (CI): 34–not available (NA)). All stent dysfunctions were successfully managed with ERCP. Ten patients died, and the median overall survival was 289 days (95% CI, 107–NA) from RFA to death. There was one case of mild abdominal pain after the procedure without serious adverse events. Conclusions: As a rescue therapy for occluded bilateral hilar metal stents due to tumor ingrowth, endoluminal RFA seemed to be safe and useful in selected patients.

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Iatrogenic Bile Duct Injury. A Significant Surgical Problem. Assessment of Treatment Outcomes in the Department's Own Material

Polish Journal of Surgery ◽

10.1515/pjs-2015-0004 ◽

2015 ◽

Vol 86 (12) ◽

Cited By ~ 2

Author(s):

Adam Bobkiewicz ◽

łukasz Krokowicz ◽

Tomasz Banasiewicz ◽

Tomasz Kościński ◽

Maciej Borejsza-Wysocki ◽

...

Keyword(s):

Laparoscopic Cholecystectomy ◽

Bile Duct ◽

Retrospective Analysis ◽

Bile Duct Injury ◽

Clinical Symptoms ◽

Open Cholecystectomy ◽

Multidisciplinary Treatment ◽

Laparoscopic Technique ◽

Primary Surgery ◽

Iatrogenic Bile Duct Injury

AbstractIatrogenic bile duct injuries (BDI) are still a challenging diagnostic and therapeutic problem. With the introduction of the laparoscopic technique for the treatment of cholecystolithiasis, the incidence of iatrogenic BDI increased.was a retrospective analysis of 69 patients treated at the department due to iatrogenic BDI in the years 2004-2014.. In this paper, we presented the results of a retrospective analysis of 69 patients treated at the Department due to iatrogenic BDI in the years 2004-2014. The data were analysed in terms of age, sex, type of biliary injury, clinical symptoms, the type of repair surgery, the time between the primary surgery and the BDI management, postoperative complications and duration of hospital stay.. 82.6% of BDI occurred during laparoscopic cholecystectomy, 8.7% occurred during open cholecystectomy, whereas 6 cases of BDI resulted from surgeries conducted for other indications. In order to assess the degree of BDI, Bismuth and Neuhaus classifications were used (for open and laparoscopic cholecystectomy respectively). 84.1% of patients with confirmed BDI, were transferred to the Department from other hospitals. The average time between the primary surgery and reoperation was 6.2 days (SD 4). The most common clinical symptom was biliary fistula observed in 78.3% of patients. In 28 patients, unsuccessful attempts to manage BDI were made prior to the admission to the Department in other centres. The repair procedure was mainly conducted by laparotomy (82.6%) and by the endoscopic approach (15.9%). Hepaticojejunostomy was the most common type of reconstruction following BDI (34.7%).. The increase in the rate of iatrogenic bile duct injury remains a challenging surgical problem. The management of BDI should be multidisciplinary treatment. Referring patients with both suspected and confirmed iatrogenic BDI to tertiary centres allows more effective treatment to be implemented.

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Metachronous biliary carcinoma with intraductal pancreatic adenocarcinoma 13 years after curative resection of hilar bile duct cancer

BMJ Case Reports ◽

10.1136/bcr-2013-202744 ◽

2014 ◽

Vol 2014 (mar04 1) ◽

pp. bcr2013202744-bcr2013202744 ◽

Cited By ~ 3

Author(s):

H. Maekawa ◽

T. Fujikawa ◽

A. Tanaka

Keyword(s):

Bile Duct ◽

Pancreatic Adenocarcinoma ◽

Bile Duct Cancer ◽

Curative Resection ◽

Biliary Carcinoma ◽

Hilar Bile Duct Cancer ◽

Hilar Bile Duct ◽

Duct Cancer

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Mixed adenoneuroendocrine carcinoma of the hepatic bile duct: a case report and review of the literature

BMC Gastroenterology ◽

10.1186/s12876-020-01550-2 ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Sulai Liu ◽

Zhendong Zhong ◽

Meng Xiao ◽

Yinghui Song ◽

Youye Zhu ◽

...

Keyword(s):

Bile Duct ◽

Neuroendocrine Tumors ◽

Radical Surgery ◽

Malignant Tumors ◽

World Health ◽

Ki 67 ◽

Mixed Adenoneuroendocrine Carcinoma ◽

Hilar Bile Duct ◽

Hilar Tumor

Abstract Background The World Health Organization's updated classification of digestive system neuroendocrine tumors in 2010 first proposed the classification of mixed adenoneuroendocrine carcinoma (MANEC). The incidence of biliary malignant tumors with neuroendocrine tumors accounts for less than 1% of all neuroendocrine tumors. Moreover, the incidence of hilar bile duct with MANEC is very rare. Case presentation A 65-year-old female patient came to our hospital for repeated abdominal pain for more than 4 months and skin sclera yellow staining for 1 week. Contrast-enhanced computed tomography imaging and magnetic resonance results suggested a hilar tumor for Bismuth-Corlette Type II. The patient underwent radical surgery for hilar cholangiocarcinoma. Finally, the patient was diagnosed with hilar bile duct MANEC, staged 1 (pT1N0M0) based on the eighth edition of the AJCC. Histopathology showed that the tumor was a biliary tumor with both adenocarcinoma and neuroendocrine carcinoma. No evidence of recurrence and metastasis after 20 months of follow-up. Conclusions We first reported a MANEC that originated in the hilar bile duct. As far as we known, there were few reports of biliary MANEC, and the overall prognosis was poor. We also found that the higher the Ki-67 index, the worse the prognosis of this type of patient. Radical surgery is the most effective treatment.

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