Professor Alberto Montori (1933-2021) was a Professor Emeritus and a pioneering figure in Italian and international digestive endoscopy and minimally invasive surgery. This manuscript summarizes Professor Montori's clinical and academic career, highlighting his impact on therapeutic endoscopy, surgical innovation, and mentorship. Professor Montori promoted endoscopic and minimally invasive approaches early in his career and helped establish structured training in surgical endoscopy. His Digestive Endoscopy Centre became a national reference center; by 1979, it was the only center in Rome performing ERCP and endoscopic papillo-sphincterotomy for biliary disease. He authored more than 446 publications and held major international leadership roles, including within UEGF, ESGE, and EAES, while also fostering international academic exchange and humanitarian surgical programs. Beyond his academic achievements, he was a devoted husband and father, and an exceptional mentor to multiple generations of students, surgical residents and attending surgeons. Professor Montori's legacy endures through the surgeons he trained and the lasting integration of therapeutic endoscopy and minimally invasive principles into modern digestive surgery. He will be deeply missed by his family and by those of us who were privileged to know him and share time with him.

Liver abscesses: Clinical-epidemiological, microbiological characteristics and mortality predictors.

Outcomes following adoption and integration of robotic-assisted cholecystectomy for pediatric biliary tract disease: An eight-year, single-center experience.

Choledocholithiasis remains a common disease process to treat in modern medicine, but few are aware of its fascinating history. Starting with the preliminary understandings of ancient civilizations, significant strides in anatomic and pathologic characterization were made during the 16-18th centuries. In the latter half of the nineteenth century, the first cholecystectomy was performed, crossing an important surgical milestone that opened the door to further biliary intervention. Diagnostic advances were made and imaging techniques improved in the twentieth century, notably with Dr. George Berci's groundbreaking advancement of cholangiography and performance of the first endoscopic common bile duct exploration. The development of endoscopic cholangiopancreatography (ERCP) in the 1970s and the introduction of laparoscopy brought the management of biliary disease into the modern era. In the future, we look towards improvements in safety, imaging techniques, instrumentation, and teaching strategies, among others, to further the field. In this article, we review the history of choledocholithiasis and the medical pioneers, importantly Dr. George Berci, who revolutionized the endoscopic and surgical treatment of this disease.

Multimorbidity and associated factors among older adults with hypertension: Network analysis based on a cross-sectional study in rural China.

The objective was to evaluate potential genetic associations between biliary system disorders and cortical and subcortical brain structural changes using Mendelian randomization analyses. This study focused on 4 diseases, including primary sclerosing cholangitis, cholecystitis, intrahepatic cholangiocarcinoma, and gallstone disease, and total bilirubin levels as indicators of biliary system disorders. Genome-wide association studies summary statistics from the ENIGMA consortium were utilized to assess the directional associations between these biliary system diseases and changes in brain structure, including the cerebral cortex (N = 51,665) and subcortical brain structures (N = 30,717). Inverse variance weighted was the primary method for conducting MR analysis. Furthermore, sensitivity analysis was conducted to evaluate the robustness of our findings. At the regional level, a decrease in the thickness of the pars opercularis was supposedly linked to genetically predicted total bilirubin levels (P = .00014). Decreased cortical thickness and surface area of the paracentral lobule were nominally associated with genetically predicted cholecystitis (PTH = .024; PSA = .042). Genetically predicted gallstone disease was correlated with an increased surface area of the transverse temporal gyrus (P = .023), while it was nominally associated with decreased thickness of the transverse temporal gyrus (P = .015), inferior parietal gyrus (P = .042), and middle temporal gyrus (P = .017). Furthermore, genetically predicted intrahepatic cholangiocarcinoma was associated with decreased thickness of the pars opercularis (P = .026) and surface area of the superior parietal gyrus (P = .013), while the thickness of the para hippocampal gyrus was increased without global weighted (P = .012) and with global weighted (P = .022). By comparison, genetically predicted primary sclerosing cholangitis was associated with a modest increase in the surface area of the para hippocampal gyrus, both with global weighted (P = .015) and without global weighted (P = .012), and was also linked to the increased thickness of the paracentral lobule (P = .016). No significant evidence of multiple testing effects or heterogeneity was observed. The research suggests an association between changes in the cerebral cortex and biliary system disorders, indicating an indirect impact of these abnormalities on cortical structures.

The objectives of this study were to outline the establishment and operationalisation of the Older Adult Surgical Inpatient Service (OASIS), a proactive, perioperative geriatric medicine in-reach service in a tertiary Acute Surgical Unit (ASU) and to describe the demographics, surgical diagnoses and management, and comprehensive geriatric assessment (CGA)-based interventions of OASIS patients. The Older Adult Surgical Inpatient Service (OASIS) was established in May 2021. Patients receiving OASIS input over 12 months were prospectively identified, and data were collected on baseline demographics, Clinical Frailty Scale (CFS), medical comorbidities, surgical diagnoses and initial CGA-based interventions. Surgical management was retrospectively cross-checked using digital medical records. The Older Adult Surgical Inpatient Service (OASIS) was established by integrating a 0.5 FTE geriatrician in a tertiary hospital ASU. Older adults were identified for review at ASU handover. The Older Adult Surgical Inpatient Service (OASIS) conducted CGA-based interventions on weekday ward rounds, supported by an ASU junior doctor. The geriatrician led the daily multidisciplinary team meeting. The Older Adult Surgical Inpatient Service (OASIS) reviewed 836 patients (median age = 78.5 years). Prior to admission, 91% (n = 761) were community dwelling, 59% (n = 497) walked unaided and 60% (n = 505) were vulnerable or frail (CFS ≥ 4). Predominant surgical diagnoses were bowel obstruction 20% (n = 177), lower gastrointestinal bleeding 19% (n = 171) and acute biliary disease 18% (n = 162). Surgical management was operative in 26% (n = 215), non-operative procedural in 20% (n = 175) and conservative in 53% (n = 446). There was a correlation between operative management decreasing as age and frailty increased. CGA-based interventions on initial review included medication changes, goals of care discussions, anticoagulation management and perioperative risk assessment. It is feasible to initiate a geriatric medicine in-reach service in a tertiary hospital ASU by integrating a 0.5 FTE geriatrician into existing resources. A multi-domain description of demographics, frailty, surgical diagnosis and management of older adults with acute surgical pathology is provided.

Aim: to determine the relationship between hepatobiliary system (HBS) pathology and oral health status based on a synthesis of professional literature. Materials and methods. A bibliosemantic analysis was performed on research results from Ukrainian and international professional literature indexed in PubMed, Scopus, Web of Science, and Google Scholar. The search utilized keywords: hepatobiliary system, liver diseases, biliary tract diseases, dental caries, periodontitis, and oral mucosal diseases. Results. The study indicates that pathological changes in the hepatobiliary complex disrupt numerous vital systemic processes. Existing research has explored the development of hepatorenal, hepatoencephalic, hepatopulmonary, dermatological, and cardiovascular syndromes associated with HBS pathology. The authors have identified a significant influence of hepatobiliary diseases on the development of oral conditions, specifically affecting the periodontium, oral mucosa, salivary glands, and dental hard tissues. Furthermore, periodontitis is increasingly recognized as a risk factor that may contribute to the progression of hepatobiliary pathology. Evidence confirms a bidirectional correlation between HBS disorders and oral tissue health. Conclusions. Impairment of hepatic metabolic functions, including protein synthesis, accumulation, and distribution, as well as hormone and vitamin regulation and the activation of pro-inflammatory processes, negatively impacts various organ systems. It has been established that microbiome alterations observed in periodontitis play a significant role in the pathogenesis of non-alcoholic fatty liver disease and non-alcoholic steatohepatitis. Hepatobiliary pathology impairs the regeneration of both connective tissue and bone structures within the oral cavity. Clinical and experimental data also confirm that viral hepatitis is frequently accompanied by pathological changes in the salivary glands.

Immediate-onset postoperative acute pancreatitis after thoracic decompression laminectomy: a case report and literature review

Biodegradable Stents in Benign Biliary and Pancreatic Disease: A Systematic Review.

Cholic acid (CA) and indoxyl sulfate (IS) are toxins associated with biliary and renal disease. Protein binding prevents removal by traditional dialysis. Dissolving binding molecules such as albumin in dialysate enables detoxification. We created a benchtop albumin dialysis test platform. We used it to validate a mathematical model of CA/IS removal. Toxin-containing blood analog solution was dialyzed using two dialyzers at five flow rates against albumin dialysate. One condition was used to estimate toxin binding affinity to albumin and the free toxin transmembrane transfer coefficient (KfreeA). Other conditions validated modeling results and revealed the impact of dialysate flow rate and dialyzer properties on detoxification (measured by mass spectrometry). We accurately predicted CA/IS removal. The normalized root mean squared error never exceeds 11.5% of the starting amount. Increasing dialysate side flow rate up to 150 mL/min improved toxin removal. Further increases produced no benefit. KfreeA was independent of flow rate. Our data fits a result from the newly developed AMOR system, in which total bile acids declined with treatment. This model and benchtop setup aim to predict clinical CA/IS clearance and optimize device design for clinical trials. This will mean fewer unsuccessful trials and enable testing of new dialysate formulations.

Background Type 2 diabetes mellitus (T2DM) increases the risk of biliary diseases (BD). This study aimed to evaluate the association between sodium-glucose cotransporter-2 inhibitors (SGLT2i) use andBD risk in T2DM patients, compared with sulfonylureas. Methods We conducted a multi-center retrospective cohort study using electronic health records from Nanjing Medical University (January 2017-September 2022). Adults aged 18–75 years with T2DM newly prescribed SGLT2i or sulfonylureas were included. Propensity score with inverse probability of treatment weighting (IPTW) was applied to balance baseline covariates. Follow-up continued until BD onset, last visit, death, or study end. Cox proportional hazards models estimated hazard ratios (HRs) with 95% confidence intervals (CIs) complemented by sensitivity analyses, time-stratified analyses and subgroup analyses. Metabolic and biliary biomarkers were also compared. Results A total of 1,901 T2DM patients were included (453 SGLT2i users and 1,448 sulfonylurea users). BD occurred in 24 SGLT2i users and in 188 sulfonylurea users. After IPTW adjustment, SGLT2i use was associated with a lower BD risk (HR 0.595, 95% CI 0.410–0.863, p = 0.020), remaining significant beyond 24 months and was stronger in patients aged over 60 years, without diabetic complications, or with high comorbidity burdens, consistent regardless of prior biguanides use. Glycemic control and body weight remained comparable, whereas SGLT2i users showed higher high-density lipoprotein cholesterol and lower total bile acid, and bilirubin levels. Conclusion SGLT2i use was associated with a lower BD risk in T2DM patients, particularly with long-term treatment and among high-risk subgroups. Improved biliary biomarkers paralleled this reduction, suggesting a potential link that warrants further study.

JAAD CME Part 2: Clinical Evidence and Safety Considerations for GLP-1 Receptor Agonists in Dermatology.

Acute pancreatitis is among the most frequent gastroenterologic reasons for hospitalization in the United States. This condition is associated with significant morbidity, including recurrent acute pancreatitis and chronic pancreatitis. Although most patient cases are due to biliary disease and ethanol, approximately 18% are idiopathic. Diagnostic and management options for idiopathic acute pancreatitis include genetic testing for a number of associated mutations and cholecystectomy to treat subclinical or undetected biliary disease. Endoscopic retrograde cholangiopancreatography, often with concomitant endoscopic sphincterotomy, is also sometimes considered in the management of idiopathic recurrent acute pancreatitis, although the role of this invasive procedure is generally limited. Here, 2 pancreatologists and coauthors of a recent American College of Gastroenterology guideline on the management of acute pancreatitis discuss issues related to genetic testing, cholecystectomy, and endoscopic retrograde cholangiopancreatography with endoscopic sphincterotomy for patients with acute idiopathic pancreatitis in general, and for a young woman recently diagnosed with this condition.

Introduction: Biliary obstruction is a common clinical disease, and magnetic resonance cholangiopancreatography (MRCP) and endoscopic retrograde cholangiopancreatography (ERCP) play an important role in the diagnosis and treatment of biliary obstruction. This study explores the localization, qualitative diagnosis, and treatment effects of MRCP and ERCP on biliary obstruction diseases. Methods: Retrospective analysis of patients diagnosed with biliary obstruction who underwent MRCP examination and ERCP treatment from October 2022 to October 2024. The patients were divided into jaundice group and non-jaundice group according to their clinical characteristics. The clinical characteristics, treatment, and accuracy of localization and qualitative diagnosis of the two groups were analyzed. Results: A total of 78 patients with biliary obstruction who underwent MRCP examination and ERCP treatment were collected, with 39 cases in jaundice group and 39 cases in the non-jaundice group. The total bilirubin level and alkaline phosphatase (ALT) level in the jaundice group were significantly lower than those before surgery, with significant differences. In terms of localization and qualitative diagnosis in both the jaundice group and non-jaundice group, the results indicate that the combination of MRCP and ERCP has a high accuracy rate for the localization and qualitative diagnosis of biliary obstruction. Conclusion: In the diagnosis of biliary obstruction diseases, MRCP and ERCP have their own advantages and disadvantages. By combining the strengths of both, accuracy of localization and qualitative diagnosis of biliary obstruction can be improved to some extent. In terms of treatment, the bilirubin and ALT levels in the jaundice group improved significantly after ERCP, indicating that ERCP is more effective in patients with biliary obstruction complicated with jaundice.

Biliary atresia (BA) is one of the most destructive liver and biliary diseases in neonates and is characterized by progressive fibrous inflammatory obstruction of the intrahepatic and extrahepatic bile ducts, ultimately leading to liver fibrosis and liver failure. This study aimed to use integrated bioinformatics methods to identify differentially expressed genes (DEGs) in BA liver tissue, identify key genes, and explore their mechanisms in liver fibrosis. We obtained data from the gene expression omnibus (GEO) dataset GSE122340 [171 BA patients and 7 normal controls (NCs)]. DEGs were screened via the limma package, followed by gene ontology (GO)/kyoto encyclopedia of genes and genomes (KEGG) enrichment analysis. A protein-protein interaction (PPI) network was constructed via STRING and Cytoscape, and core genes were selected via the maximum clique centrality (MCC), maximum neighborhood component (MNC), and degree algorithms from the CytoHubba plugin. Further focus was placed on the key gene EGF-like repeats and discoidin I-like domains 3 (EDIL3) through gene set enrichment analysis (GSEA), expression validation, subcellular localization analysis, and clinical tissue sample validation. To minimize batch effects, we performed ComBat correction on the combined gene expression data of GSE122340 and the validation dataset GSE46960 before interdataset comparison. We identified a total of 3706 DEGs, including 2774 upregulated DEGs and 932 downregulated DEGs. The functional enrichment analysis revealed that the DEGs were involved mainly in biological processes such as the cell cycle, DNA replication, and extracellular matrix organization, as well as signaling pathways such as herpes simplex virus infection, phosphoinositide 3-kinase (PI3K)-protein kinase B (AKT), and tumor necrosis factor (TNF). Protein-protein interaction (PPI) network analysis revealed 7 core genes (BRCA1, TOP2A, BRCA2, BUB1B, HSP90AA1, PLK4, and EDIL3), with EDIL3 showing the greatest increase in BA. EDIL3 is located on chromosome 5, and its encoded protein is expressed primarily in the cell membrane and extracellular region. GSEA indicated that high EDIL3 expression was significantly associated with apoptosis and activation of the PI3K-AKT signaling pathway. Clinical sample validation revealed that EDIL3 expression was significantly elevated in BA liver tissue, and its high expression was significantly negatively correlated with the survival rate of patients' native livers. Discoidin I-like domain 3 is a novel gene with a potentially key role in BA-related liver fibrosis, possibly influencing the proliferation and apoptosis of cholangiocytes by regulating the PI3K-AKT signaling pathway, thereby participating in the occurrence and development of liver fibrosis. This study provides new insights into the molecular mechanisms and potential treatment strategies for BA.

Endoscopic Retrograde Cholangiopancreatography (ERCP) is a procedure that combines endoscopy and fluroscopy primarily available in tertiary centers. Limited access in non-urban settings often results in delayed diagnosis and intervention. This study reviews the journey of ERCP service in a district hospital in Temerloh, Pahang, assessing feasibility, safety, and outcomes. ERCP service has been extended to several districts in Central Pahang including Temerloh, Maran, Bera, Bentong, Raub, Jerantut, Cameron Highland and Lipis - serving an estimated combined population of approximately 450,000 people.

To explore the application value of three-dimensional breath-hold gradient spin echo sequence (3D BH-GRASE) in MRCP. We conducted MRCP imaging on 56 patients with pancreatic and biliary diseases via both 3D BH-GRASE and 3D NT-TSE. We compared and statistically analysed the acquisition time, signal-to-noise ratio (SNR), contrast ratio (CR), contrast-to-noise ratio (CNR), and image quality between the two techniques. The mean image acquisition time of 3D BH-GRASE was 16.4s, which was significantly shorter than the (238.12 ± 43.85) seconds required for 3D NT-TSE (p < 0.05). Compared with3D NT-TSE, 3D BH-GRASE achieved superior scores in overall image quality, artifacts, and visualization of the common bile duct, hepatic duct, and gallbladder/cystic duct (p < 0.05), but not in the left/right hepatic ducts. In contrast, 3D BH-GRASE was significantly inferior to 3D NT-TSE in visualizing the left and right secondary hepatic ducts (p < 0.05), although not for the pancreatic duct. The image quality scores of the 3D NT-TSE group combined with the 3D BH-GRASE group were significantly greater than those of the individual sequences (p < 0.05). 3D BH-GRASE addresses image quality concerns arising from motion artefacts in 3D NT-TSE and serves as a valuable supplementary imaging modality.

Bile contains many bacteria that can contribute to various diseases. Therefore, identifying bile microbiome differences between benign and malignant conditions is essential. In this study, bile samples were collected aseptically from 141 patients with biliary tract cancer (BTC) or benign biliary diseases (BBDs) who underwent endoscopic retrograde cholangiopancreatography or biliary tract surgery. Quality control PCR was performed to amplify the V3–V4 region of the bacterial 16S rRNA gene. Metagenomic sequencing of bile was successfully performed in 35 of 56 samples collected from patients with BTC and 24 of 85 samples from patients with BBD. The mean alpha diversity values comprised 2.788 ± 2.833 and 2.319 ± 1.355 in the BBD and BTC groups, respectively (p = 0.399). The bacterial species (4.7%) were shared between groups, whereas 12.3% and 83% were indicated to patients with BTC and BBD, respectively. Bacteroides coprocola, Prevotella copri, and Bacteroides plebeius were more frequently identified in the bile of patients with BTC, whereas Bacteroides vulgatus and Bacteroides uniformis were more abundant in the bile of patients with BBD. Distinct patterns of microorganism abundance between the two groups of patients suggest association of bile microbiome with disease status, so its diagnostic potential should be validated in further studies.

ObjectiveThis study aimed to summarize the clinical experience of Endoscopic Retrograde Cholangiopancreatography (ERCP) in a pediatric population, analyzing the disease spectrum, procedural characteristics, and clinical outcomes to contribute to the understanding of its application in children.MethodsThis study reviewed the clinical data of children who presented to our hospital and underwent ERCP and related procedures between January 2021 and December 2024. Collected data encompassed patient demographics, specific disease indications, detailed endoscopic techniques employed, procedural success rates, and the incidence and management of related complications.ResultsThe study cohort had a mean age of 8.31 ± 3.63 years. The primary indication for ERCP was pancreatic disease, accounting for 72% (134/186) of procedures. These included chronic pancreatitis (n = 75), pancreatic trauma (n = 17), and acute pancreatitis with pseudocysts (n = 17). Biliary diseases constituted 28% (52/186), mainly choledocholithiasis (n = 33) and pancreatobiliary maljunction (n = 9). Commonly performed endoscopic interventions were pancreatic duct stent placement (n = 95), biliary stent placement (n = 50), and stone extraction from both ducts (n = 70 and 33, respectively). The overall procedural success rate was 90.5% (171/186). A significant difference was noted when stratified by operation time: procedures completed within 60 min had a 96.7% (115/119) success rate, compared to 80.0% (56/70) for those lasting 60 min or longer (P < 0.001). Post-procedure complications were recorded in 11 cases (5.9%), including post-pancreatitis (n = 6), infection (n = 4), and gastrointestinal bleeding (n = 1).All complications were all resolved with conservative medical management.ConclusionThis study confirms that pancreatic diseases (accounting for 72%) are the main indication. Endoscopic Retrograde Cholangiopancreatography (ERCP) has a high success rate (90.5%) in the diagnosis and treatment of biliary and pancreatic diseases in children. However, prolonged procedure time (>60 min) significantly reduces the success rate.