Biliary Drainage Tube Research Articles

Efficacy of oncolytic virus combined with HAIC of mFOLFOX for IMCC: A single-center, single-arm, prospective study.

e16265 Background: Hepatic arterial infusion chemotherapy (HAIC) is a well-established treatment for liver cancer. Our previous studies have demonstrated the effectiveness of HAIC with modified FOLFOX (mFOLFOX) for intrahepatic cholangiocarcinoma. However, intrahepatic mass-forming cholangiocarcinoma (IMCC) patients often lose the therapeutic opportunity due to obstructive jaundice caused by huge tumor compression. On the other hand, recombinant human adenovirus type 5 Injection (H101), an oncolytic virus (OVs), has direct anticancer effects and enhances cell-mediated immune responses. Therefor, this clinical study was designed to improve the prognosis of IMCC by the combination of OVs injection and HAIC. Methods: In this study, patients with unresectable IMCC and confirmed by biopsy were enrolled. H101 was used by ultrasound-guided injections 1-3 days before HAIC (a dosage of ≤10 cm, 1.0×1012 vp; ≥10 cm, 1.5×1012 vp). Then, patients were treated with HAIC, which is a night-administration regimen of 50 mg oxaliplatin plus 1.5g 5-fluorouracil and leucovorin, continuous infusion for 2-3 days. Patients received 4-6 cycles of treatment. The primary outcome was progression-free survival (PFS), the secondary outcomes were overall survival (OS), objective response rate (ORR), disease control rate (DCR), and quality of life (QOL). Efficacy assessments were conducted every four weeks following mRECIST v1.1 criteria. Quality of life was assessed by the WHOQOL-BREF scale. Results: From April 1, 2022 to February 1, 2024, 11 patients were enrolled. The median age was 57 years (range 36-73) and the mean tumor diameter was 8.6cm (range 4.3-11.7cm). The primary endpoint was met with a mPFS of 9.6 months. The mOS was 13.2 months. ORR was 36.3% (4/11), and DCR was 90.9% (10/11). CA-199 decreased from 2036.47 to 560.55 U/ml (P < 0.01). The CD8+ T cells increased significantly (306.94 VS. 448.7 cell/ul, P < 0.05), but the CD4+ T cells were with a steady tendency (425.41 VS. 583.50 cell/ul, P = 0.32). In addition, all patients were placed 1-3 biliary drains before enrollment. After OVs plus HAIC treatment, 7 patients had removed or closed their biliary tract drainage tubes, and the QOL score increased from 71.23 to 77.18. Significantly, during the puncture operation, the tumor texture became softer during the multi-cycle OVs plus HAIC treatment. It explains why the tumor pressure on the biliary tract was quickly relieved and the biliary drainage tube was removed in most enrolled IMCC patients. Conclusions: The combination of OVs injection and HAIC with mFOLFOX showed promising anti-tumor and immune-activation efficacy in IMCC. Meanwhile, this strategy has an effect on relieving the pain and malnutrition of long-term biliary drainage and improving the quality of life of patients. Even more, the OVs plus HAIC regimen may be more effective, if combined with the immune checkpoint inhibitors in the future. Clinical trial information: NCT05124002 .

Myiasis in Percutaneous Transhepatic Biliary Drainage Site

AbstractThe infection of dipterous larvae causes myiasis. It is generally associated with unsanitary conditions. An interventional radiologist rarely comes across myiasis. We report a case of myiasis around a percutaneous transhepatic biliary drainage (PTBD) tube. A 31-year-old man from a rural area underwent left PTBD for cholangiocarcinoma and was discharged with an internal–external drain. Two weeks later, he presented with pain in the local site, pruritus, and bile leakage. He was found to have maggots around the PTBD tube with poor wound hygiene. Treatment included turpentine oil instillation and oral and topical ivermectin, accompanied by manual removal of the larva.

Application of percutaneous biliary drainage in the treatment of post-operative bile leakage after liver rupture: A case report.

Post-operative bile leakage (POBL) is a serious complication following hepatobiliary surgery, with potentially life-threatening consequences if left untreated. This article presents a successful case of POBL management without surgical intervention. A 31-year-old male, diagnosed with bile leakage before hospitalisation, underwent percutaneous biliary drainage (PTBD) to address bilomas. Follow-up after 3 months indicated biloma atrophy and POBL healing but revealed bile duct stenosis. The patient received a larger biliary drainage tube, and after 1 month, the biloma and tube were removed. A 1-year follow-up confirmed the patient's excellent health. This case underscores the safety and efficacy of PTBD for managing POBL, offering a non-invasive alternative for patients with this complication. PTBD presents a viable treatment option for POBL cases, minimising the need for surgical interventions and their associated risks.

A case of non-ampullary duodenal adenosquamous carcinoma with successful emergency pancreaticoduodenectomy for gastrointestinal hemorrhage

BackgroundAlthough most duodenal carcinomas are pathological adenocarcinomas, a small number of cases have been reported of adenosquamous carcinoma, characterized by variable combinations of two malignant components: adenocarcinoma and squamous cell carcinoma. However, owing to the small number of cases of non-ampullary duodenal adenosquamous carcinoma, there have been no reported cases of emergency pancreaticoduodenectomy for gastrointestinal hemorrhage due to non-ampullary duodenal adenosquamous carcinoma.Case presentationA 66-year-old Japanese male presented to the referring hospital with a chief complaint of abdominal pain, diarrhea, and dark urine that had persisted for 1 month. The patient was referred to our hospital because of liver dysfunction on a blood examination. Laboratory results of the blood on the day of admission showed that total and direct bilirubin levels (12.0 mg/dl and 9.6 mg/dl) were markedly increased. An endoscopic retrograde biliary drainage tube was inserted for the treatment of obstructive jaundice, and imaging studies were continuously performed. Contrast-enhanced computed tomography and endoscopy revealed an ill-defined lesion involving the second portion of the duodenum, predominantly along the medial wall, and measuring 60 mm in diameter. No metastases were observed by positron emission tomography. Pancreaticoduodenectomy was planned based on the pathological findings of poorly differentiated adenocarcinoma. However, 2 days before the scheduled surgery, the patient experienced hemorrhagic shock with melena. Owing to poor hemostasis after endoscopic treatment and poor control of hemodynamic circulation despite blood transfusion, radiological embolization and hemostasis were attempted but were incomplete. An emergency pancreaticoduodenectomy was performed after embolizing the route from the gastroduodenal artery and pseudoaneurysm area to reduce bleeding. The operation was completed using an anterior approach without Kocherization or tunneling due to the huge tumor. The operation time was 4 h and 32 min, and blood loss was 595 mL The pathological diagnosis was adenosquamous carcinoma. The postoperative course was uneventful with 17 day hospital stay and the patient is currently well, with no signs of recurrence 9 months after surgery.ConclusionsThis report presents an extremely rare case of successful emergency pancreaticoduodenectomy for gastrointestinal hemorrhage caused by non-ampullary duodenal adenosquamous carcinoma.

Optimizing surgical management of iatrogenic bile duct injury: transhepatic percutaneous cholangial drainage combined with end-to-end biliary anastomosis.

Iatrogenic bile duct injury remains the most severe complication of gallbladder surgeries. To reduce post-operation complication, we introduce an improved approach for bile duct injury repairment, named transhepatic percutaneous cholangial drainage (TPCD) which combined with end-to-end biliary anastomosis. Clinical data obtained from 12 patients between February 2012 and May 2022 were retrospectively analyzed. Patient demographic, clinical, operative, and follow-up data were analyzed using descriptive statistics. All injuries were repaired successfully and no fatal cases occurred. The mean operative time and hospital stay duration were 367.5 ± 103.2min and 11.3 ± 3.5days, respectively. In two cases (16.7%), bile leakage occurred at the bile duct anastomosis site. Three patients (25.0%) developed low-grade fever and one patient (8.3%) developed a postoperative infection of the incision site. No postoperative bleeding or bile duct strictures occurred in any of the cases. The patients were followed up from 12 to 122months (median, 70.5months). No cholangitis or bile duct restenosis was observed after biliary drainage tube removal. There were no long-term bile duct-related complications seen in the follow-up time. It is safe and feasible for TPCD combined with end-to-end biliary anastomosis using in bile duct injury.

Phosphatidylcholine in bile-derived small extracellular vesicles as a novel biomarker of cholangiocarcinoma.

Owing to the lack of definite diagnostic modalities, it is challenging to distinguish malignant cases of cholangiocarcinoma (CCA), which often causes biliary tract obstruction, from benign ones. Here, we investigated a novel lipid biomarker of CCA in bile-derived small extracellular vesicles (sEVs) and developed a simple detection method for clinical application. Bile samples from seven patients with malignant diseases (hilar CCA = 4, distal CCA = 3) and eight patients with benign diseases (gallstones = 6, primary sclerosing cholangitis = 1, autoimmune pancreatitis = 1) were collected through a nasal biliary drainage tube. sEVs were isolated via serial ultracentrifugation and characterized using nanoparticle tracking analysis, transmission electron microscopy, and immunoblotting (with CD9, CD63, CD81, and TSG101). Comprehensive lipidomic analysis was performed using liquid chromatography-tandem mass spectrometry. Using a measurement kit, we further confirmed whether lipid concentrations could be used as a potential CCA marker. Lipidomic analysis of bile sEVs in the two groups identified 209 significantly increased lipid species in the malignant group. When focusing on lipid class, phosphatidylcholine (PC) level was 4.98-fold higher in the malignant group than in the benign group (P = 0.037). The receiver operating characteristic (ROC) curve showed a sensitivity of 71.4%, a specificity of 100%, and an area under the curve (AUC) of 0.857 (95% confidence interval [CI]:0.643-1.000). Using a PC assay kit, the ROC curve showed a cutoff value of 16.1 μg/mL, a sensitivity of 71.4%, a specificity of 100%, and an AUC of 0.839 (95% CI: 0.620-1.000). PC level in sEVs from human bile is a potential diagnostic marker for CCA and can be assessed by a commercially available assay kit.

Application and clinical evaluation of ultrasound-guided biliary drainage tube replacement technology

Application and clinical evaluation of ultrasound-guided biliary drainage tube replacement technology

Pancreatoblastoma of the pancreatic head with portal tumor embolism in a 2-year-old boy

A 2-year-old boy visited the hospital with a complaint of grayish white stool. A pancreatic tumor was found on investigation. The tumor was located at the head of the pancreas, and the common bile duct was completely occluded by the tumor and surrounding lymph nodes. A tumor embolism in the portal vein was observed. Development of accessory blood circulation associated with tumor embolization in the portal vein was observed. Tumor biopsy and biliary drainage tube placement were performed. The tumor was diagnosed as pancreatoblastoma. Pylorus-preserving pancreaticoduodenectomy was performed after three courses of chemotherapy. For the portal vein tumor plug, the portal vein was opened, and as much of the tumor plug was removed as possible. Anastomosis of the pancreas and small intestine was performed using the pancreatic duct insertion method, and the pancreatic juice was completely discharged from the body. After the operation, it was suspected that there was a small tumor remnant in the portal vein. Postoperative high-dose chemotherapy with peripheral blood stem cell transplantation and proton beam therapy were performed as additional treatments. Currently, the patient has been alive for 7 years without recurrence.

Percutaneous Transhepatic Biliary Intervention in Adult Biliary Atresia Patients After Kasai Portoenterostomy.

Kasai portoenterostomy (KP) is a standard treatment for patients with biliary atresia (BA). After KP, patients with BA occasionally develop biliary complications, such as recurrent cholangitis, biliary stricture, and cystic dilatation of the intrahepatic bile duct. Percutaneous transhepatic biliary drainage is one of the treatment options for these biliary complications. However, limited information is available on percutaneous transhepatic biliary drainage performed after KP in adult BA patients with native livers. Herein, we describe 8 cases of percutaneous transhepatic biliary interventions performed after KP in 7 adult BA patients with native livers. Cholangiography showed multiple cystic dilatation of the intrahepatic bile ducts. Advancing a guidewire and catheter was difficult due to the multiple dilatations and strictures of the bile duct. Successful biliary drainage tube placement and clinical improvement was achieved in 5 and 3 cases, respectively. Because of its technical difficulty and limited clinical effectiveness, it is not recommended that it be performed easily.

Primary Sclerosing Cholangitis in a Paediatric Patient: An Atypical Presentation

Primary sclerosing cholangitis (PSC) is an autoimmune chronic liver disease that studies have shown is rare in children. Here, a challenging case of PSC in a 13-year-old male, without preceding manifestations of inflammatory bowel disease and with evidence of biliary obstruction, is reported. The patient presented with progressive scleral icterus; their total bilirubin and alkaline phosphatase levels were raised, with negative autoimmune work-up, and an ultrasound scan of their abdomen was unremarkable. Magnetic resonance cholangiopancreatography revealed marked dilatation of the intra- and extrahepatic bile ducts, with strictures in the hepatic duct and proximal common bile duct (CBD). Endoscopic retrograde cholangiopancreatography revealed a very narrow CBD with high-grade severe biliary stricture at the common hepatic duct. A cholangiogram revealed the beaded appearance of the intrahepatic ducts, and a left percutaneous external biliary drainage tube was placed. Overall, the findings were suggestive of PSC with high-grade CBD strictures. This case is unique due to the absence of preceding clinical manifestations of inflammatory bowel disease and predominantly obstructive symptoms at the time of presentation, which is highly unusual in the paediatric population.

A125 A NOVEL TECHNIQUE COMBINING EUS AND SPYGLASS DS SYSTEM GUIDANCE FOR BOTH THE DIAGNOSIS AND MANAGEMENT OF AFFERENT LIMB SYNDROME

BackgroundAfferent limb syndrome is obstruction of a biliary-enteric limb following pancreaticoduodenectomy. In the past, treatment was limited to surgery or insertion of a percutaneous transhepatic biliary drainage tube. A more recent approach to treatment is Endoscopic Ultrasound (EUS)-guided gastrojejunostomy using a lumen apposing metal stent (LAMS). It was first described in two single case reports in 2015 and has been growing in its application. We present a case series of 2 patients where afferent limb syndrome was successfully managed with EUS guided gastrojejunostomy using LAMS.Aims1-To demonstrate a novel technique for diagnosis and management of afferent limb syndrome.MethodsCase # 1- 79 year old female post Whipple’s surgery for ampullary carcinoma, presented two years after surgery with significant nausea and vomiting. CT scan showed obstruction of the afferent loop suspicious for local tumor recurrence. Patient underwent EUS-guided gastrojejunostomy with successful insertion of 20 x 10 mm (AXIOS EC, Boston Scientific) stent.Case # 2-. A 51 year old male with pancreatic CA status post Whipple surgery presented with worsening abdominal pain and nausea. CT scan confirmed afferent limb syndrome. He underwent EUS- guided gastrojejunostomy with successful placement of 10 x 10 mm (AXIOS EC, Boston Scientific).ResultsCase #1: Patient improved dramatically within days and resumed oral diet. Fourteen days later, an upper endoscopy was performed in order to assess the stricture via an anterograde approach. The adult Olympus HQ gastroscope was advanced through the AXIOS stent into the afferent limb to the level of the stenosis where a tight stricture was seen. Multiple biopsies taken and were negative for malignancy. Four weeks later, she continued to tolerate oral diet well with no abdominal pain or discomfort.Case # 2: Patient continued to do well clinically 12 weeks post operation. Follow-up upper endoscopy was performed to determine the etiology of the obstruction but due to a sharp angulation, the gastroscope could not be advanced through the AXIOS stent. As such, we advanced an adult Olympus 1T gastroscope down to the site of the AXIOS stent and then utilized the Spyglass DS system to advanced deep into the afferent limb to the level of the stricture and took multiple biopsies for diagnostic purposes.ConclusionsInterventional endoscopic management of afferent limb syndrome has been evolving in the past few years with EUS guided LAMS gastrojejunostomy becoming a well stablished modality. We have demonstrated this technique with subsequent endoscopic anterograde assessment. In one of these cases, this anterograde assessment was performed using the cholangioscope in conjunction with the gastroscope to overcome unfavorable angulated anatomy which to our knowledge has not been described in the literature previously. Funding AgenciesNone

Preliminary application of brachytherapy with double-strand 125I seeds and biliary drainage for malignant obstructive jaundice.

To evaluate the efficacy and safety of brachytherapy with double-strand 125I seeds and biliary drainage for malignant obstructive jaundice. 42 patients with obstructive jaundice because of extrahepatic cholangiocarcinoma were enrolled. 22 patients (group A) received a biliary stent with common drainage tube implantation, and 20 patients (group B) received a biliary stent with double-strand 125I seeds radiotherapy drainage tube placement. The length, location and pathological stage of biliary stricture were recorded in the two groups. Total bilirubin (TBIL), direct bilirubin (DBIL), IgA, IgG, IgM, alanine aminotransferase and white blood cell (WBC) count were measured before and after percutaneous transhepatic cholangial drainage (PTCD). Tumor diameter was measured before and three months after PTCD, and the difference were calculated. Stent patency time, survival time, and complications were recorded. There was no significant difference in the length, location and pathological stage of biliary stenosis between the two groups. There was no significant difference in TBIL, DBIL, IgA, IgG, IgM, alanine aminotransferase and WBC count between the two groups before or after PTCD (P > 0.05). Three months after PTCD, tumors growth in group A and tumors shrinkage in group B. The difference in tumor size between the two groups before and after PTCD was statistically significant (P < 0.05). The average stent patency times in groups A and B were 3.55 ± 0.76months and 8.76 ± 1.85months, respectively (P < 0.05). The average survival times in groups A and B were 133.5 ± 27.8days and 252.5 ± 114.5days, respectively (P < 0.05). There was no statistically significant difference in the incidence of complications between the two groups (P > 0.05). Double-strand 125I seeds radiotherapy biliary drainage tubes can safely and effectively control tumors, prolong the patency of biliary stents, and prolong patient survival.

Fatal pancreatic fistula after laparoscopic distal pancreatectomy for intraductal papillary mucinous carcinoma with pancreaticobiliary maljunction and sphincterotomized papilla: a case report

BackgroundPancreatic juice is constantly activated by contaminated bile in patients with pancreaticobiliary maljunction (PBM). Here, we report a case of laparoscopic distal pancreatectomy for a patient with PBM and sphincterotomized papilla, resulting in fatal pancreatic fistula.Case presentationA 79-year-old man was diagnosed with pancreatic intraductal papillary mucinous neoplasm and common bile duct stones. Endoscopic sphincterotomy was performed prior to surgery. The pancreatic duct was simultaneously visualized when the contrast agent was injected into the common bile duct. Sudden bleeding was observed from the abdominal drain on postoperative day (POD) 6. Emergent stent graft placement and coil embolization were performed for bleeding from the splenic artery. On POD 9, the drainage fluid changed to yellowish in color with bile contamination. For internal drainage of the digestive fluid, endoscopic retrograde biliary tube and pancreatic drainage tube were placed. On POD 24, second emergent coil embolization was performed for bleeding from the left gastric artery. On POD 25, open abdominal drainage was performed. On POD 32, third emergent coil embolization was performed for bleeding from the gastroduodenal artery. Subsequently, remnant pancreatic resection was performed. On POD 39, massive bleeding was again observed from the abdominal drain. Emergency arterial portography revealed bleeding in the right wall of the superior mesenteric vein. The patient died of hemorrhagic shock on the same day.ConclusionsThe extreme risk of severe pancreatic fistula after distal pancreatectomy should be considered in patients with PBM and sphincterotomized papilla. In this extraordinary situation, surgeons should promptly decide whether to resect the remnant pancreas to prevent losing the patient.

Successful transpapillary removal of a migrated percutaneous transhepatic biliary drainage tube with a digital peroral cholangioscope

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Over-the-scope-clip treatment for perforation of the duodenum after endoscopic papillectomy.

Over-the-scope-clip treatment for perforation of the duodenum after endoscopic papillectomy.

Extraluminal recanalization for postoperative biliary obstruction using transseptal needle

BackgroundPostoperative biliary strictures are commonly related to accidental bile duct injuries or occur at the site of biliary anastomosis. The first-line treatment for benign biliary strictures is endoscopic therapy, which is less invasive and repeatable. However, recanalization for biliary complete obstruction is technically challenging to treat. The present report describes a successful case of treatment by extraluminal recanalization for postoperative biliary obstruction using a transseptal needle.Case presentationA 66-year-old woman had undergone caudal lobectomy for the treatment of hepatocellular carcinoma. The posterior segmental branch of the bile duct was injured and repaired intraoperatively. Three months after the surgery, the patient had developed biliary leakage from the right hepatic bile duct, resulting in complete biliary obstruction. Since intraluminal recanalization with conventional endoscopic and percutaneous approaches with a guidewire failed, extraluminal recanalization using a transseptal needle with an internal lumen via percutaneous approach was performed under fluoroscopic guidance. The left lateral inferior segmental duct was punctured, and an 8-F transseptal sheath was introduced into the ostium of right hepatic duct. A transseptal needle was advanced, and the right hepatic duct was punctured by targeting an inflated balloon that was placed at the end of the obstructed right hepatic bile duct. After confirming successful puncture using contrast agent injected through the internal lumen of the needle, a 0.014-in. guidewire was advanced into the right hepatic duct. Finally, an 8.5-F internal–external biliary drainage tube was successfully placed without complications. One month after the procedure, the drainage tube was replaced with a 10.2-F drainage tube to dilate the created tract. Subsequent endoscopic internalization was performed 5 months after the procedure. At the 1-year follow-up examination, there was no sign of biliary obstruction and recurrence of hepatocellular carcinoma.ConclusionsRecanalization using a transseptal needle can be an alternative technique for rigid biliary obstruction when conventional techniques fail.

Laparoscopic Retrograde Biliary Drainage Tube Stenting Technique of Hepaticojejunostomy for Preventing Anastomotic Stenosis of a Small Hepatic Duct: A Case of Choledochal Cyst in a Small Infant

Abstract Background: Laparoscopic hepaticojejunostomy for choledochal cyst in children is one of the most technically challenging operative procedures.1 Recent advances in high-definition imaging m...

Transcholecystic Contrast-Enhanced Ultrasound-Guided Percutaneous Transhepatic Biliary Drainage for Central Bile Duct Protection During Thermal Tumor Ablation

Intraductal cooling via a percutaneous transhepatic biliary drainage tube holds great promise in facilitating thermal ablation of liver tumors adjacent to the central bile ducts. However, the difficulties and complications associated with puncturing nondilated bile ducts are greater than those associated with puncturing dilated bile ducts. As reported here, percutaneous transcholecystic contrast-enhanced ultrasound was performed in 7 patients to visualize the nondilated bile ducts and guide percutaneous transhepatic biliary drainage, thus facilitating the intraductal cooling-assisted thermal ablation process. The procedures were technically successful in all 7 patients, and no major complications were recorded during the follow-up period.

Clinical impact of irreversible electroporation ablation for unresectable hilar cholangiocarcinoma

Irreversible electroporation (IRE) is a non-thermal ablation modality that has been shown to be safe and effective in its application to tumors that are close to risky areas. This study aims to assess the safety and efficacy of IRE for unresectable hilar cholangiocarcinoma. Nine patients from two medical centers in Asia received IRE treatment between June 2015 and July 2017. Before IRE treatment, percutaneous biliary decompressions had been performed on eight patients, and internal stenting had been performed on one patient. All patients tolerated the procedure well without high-grade complications. The ablated tumors had constant size without contrast enhancement for more than three months in eight patients and the level of CA19-9 decreased significantly in all patients. The percutaneous biliary drainage tube was removed from two patients with recanalization of the bile duct. The internal stent in one patient was removed without further stenting. The median overall survival period was 26 months, and the progression-free survival was 18 months. Bile ducts remained narrow in the majority (2/3) of the treated patients. Nevertheless, IRE ablation of unresectable hilar cholangiocarcinoma involving vital structures is a safe and feasible primary treatment for local tumor control and is effective in prolonging survival.

КЛИНИКО-ЭПИДЕМИОЛОГИЧЕСКИЕ ОСОБЕННОСТИ ПРИ ОЧАГОВОЙ ПАТОЛОГИИ ГОЛОВКИ ПОДЖЕЛУДОЧНОЙ ЖЕЛЕЗЫ НА ФОНЕ ХРОНИЧЕСКОГО ОПИСТОРХОЗА

In this retrospective study basic morphologic, clinical and epidemiological features of pancreatic head lesions in patients with and without concomitant chronic opisthorchiasis are compared. The analysis of 63 consecutive pancreaticoduodenectomies performed at out low-volume center from 2007 to 2019 revealed increased rate of opisthorchiasis being present simultaneously with neoplastic and benign pancreatic head lesions in rural population which is due to dietary habits of suburbanite. Active cholangitis in comorbid patients was seen 13,6 times more often when compared with “pure” lesion. Daily amount of bile (in patients with biliary drainage tubes) was on average 105 ml more in the group of patients with chronic opisthorchiasis. Surprisingly, we didn’t observe some morphologic features we expected in Opisthorchis felineus group. The rates of hard pancreatic stumps and wide pancreatic ducts were equal in both group of patients. However, further studies should reveal, if O. felineus is independent risk factor for biliary and/or pancreatic fi stula.