Language：English   Publisher：Endoscopy  

DOI： 10.1055/a-2234-4075

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Language：English   Publisher：Clinical Journal of Gastroenterology  

An asymptomatic 77-year-old man with intrahepatic bile duct dilation was referred to our hospital. Cholangiography revealed alternations between strictures and dilated segments from the right and left hepatic ducts to the lower bile ducts, with findings of a pruned tree, beaded, shaggy appearance, and diverticulum-like outpouching. Histopathology revealed abundant immunoglobulin G4 (IgG4)-positive plasma cells (> 10 per high-power field) with an IgG4/IgG-positive cell ratio of 40–50%. After 2 weeks of steroid therapy, the cholangiography markedly improved. Because the cholangiographic findings resembled those of primary sclerosing cholangitis, steroid therapy proved useful in differentiating IgG4-related sclerosing cholangitis from primary sclerosing cholangitis.

DOI： 10.1007/s12328-023-01903-w

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PubMed

Language：English   Publisher：Journal of Hepato-Biliary-Pancreatic Sciences  

Background/Purpose: Data on the prognosis of endoscopic papillectomy (EP) for ampullary carcinoma (AC) is limited; therefore, we aimed to identify the factors associated with endoscopically controlled AC. Methods: Between January 2003 and October 2022, 75 patients underwent EP for ampullary tumors and were diagnosed with AC based on the pathological features of the resected tissue. The factors associated with additional surgery after EP were also evaluated. Results: A total of 67 patients had ACs ranging from carcinoma in situ to tumors limited to the mucosa (M group), and eight patients had ACs ranging from those limited to the sphincter of Oddi to those invading the duodenal muscularis propria (OD group). The 3-year endoscopic tumor control (condition not requiring additional surgery) rates in the M and OD groups were 90.8% and 84.6% (p =.033), respectively. In the M group, the presence of tumor components in the resection margins was the only significant factor associated with additional surgeries (p =.010) in the univariate analysis. The 3-year endoscopic tumor control rates were 100% for negative and uncertain resection margins and 76.6% for positive margins (p =.009). Conclusions: If the AC is confined to the mucosa and the resection margins are negative or uncertain, the tumor can be well-controlled endoscopically.

DOI： 10.1002/jhbp.1375

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Language：English   Publisher：Nagoya Journal of Medical Science  

Endoscopic papillectomy is widely performed to treat duodenal papillary tumors, particularly at highvolume centers. It is indicated for adenomas without intraductal extension of the bile or pancreatic ducts. However, despite numerous reports of carcinomas that expand the indications to include well-differentiated adenocarcinomas that do not invade the sphincter of Oddi, the low agreement between biopsy and final pathological diagnosis, as well as the current inability of imaging modalities to diagnose sphincter of Oddi invasion, makes it difficult to consider expanding indications. Although complications can be prevented by certain methods, such as pancreatic duct stenting, and the frequency of severe complications has decreased, the safety of the procedure remains unconfirmed. In the future, this technology is expected to progress and enable wider applications, including those in tumors with extensive horizontal spread and those with intraductal extension of the bile and pancreatic ducts. Such technology may also improve the safety and accuracy of diagnosis.

DOI： 10.18999/nagjms.85.4.648

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PubMed

Language：Japanese   Publisher：Japan Biliary Association  

<p>We compared the clinical features and long-term prognosis of 159 patients with type 1 autoimmune pancreatitis (AIP) with and without bile duct involvement. Eighty-nine (56%) patients had bile duct involvement. Forty-nine patients (30.8%) had relapse, with a significantly higher cumulative relapse rate in patients with stenosis or wall thickening upstream of the intrapancreatic bile duct (3 years: 24% vs. 37.1%, <i>P</i><0.001). A significantly higher rate of two or more relapses (5.1% vs. 19.5%, <i>P</i>=0.01) was also found in these patients. Two patients with stenosis/dilatation up to the intrahepatic bile ducts became steroid-dependent and were treated with azathioprine. Type 1 AIP patients with stenosis and wall thickening upstream of the intrapancreatic bile ducts have a high relapse rate and may become steroid-dependent, especially in cases with stenosis and dilation extending into the intrahepatic bile ducts.</p>

DOI： 10.11210/tando.37.754

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