Extrahepatic Biliary Obstruction Research Articles

Computed tomographic diagnosis of a common bile duct abscess and secondary extrahepatic biliary duct obstruction in a potbelly pig.

A potbelly pig was evaluated for anorexia and icterus. Clinicopathologic abnormalities suggested an active inflammatory hepatobiliary process. Ultrasound and CT of the abdomen revealed an extrahepatic biliary obstruction of the common bile duct (CBD). Surgical exploration and choledochotomy revealed a markedly dilated CBD containing a large volume of intraluminal inspissated biliary material. This case report describes the imaging findings of an extrahepatic biliary obstruction secondary to abscessation within the CBD in a pig.

An unusual cause of biliary obstruction: a case report

Abdominal aortic aneurysms are considered as an unusual cause of extraductal biliary obstruction with less than 30 case studies found within the literature. This case report will discuss an 81-year-old female with an incidental initially asymptomatic finding of extrahepatic biliary obstruction and gallbladder distension secondary to an abdominal aortic aneurysm in routine computed tomography staging scan. Extraductal biliary obstructions can require alternative or additional interventions to that of treatment for intraductal obstruction. Subsequently, the aetiology of biliary obstruction is important for clinicians to consider and recognise, to allow for the implementation of appropriate and timely management.

A Case of Neonatal Diabetes and Multiple Congenital Anomalies: Variant of Mitchell-riley/Martinez-frias Syndrome

Neonatal diabetes along with congenital anomalies like duodenal atresia, tracheoesophageal fistula, intra uterine growth retardation, extrahepatic biliary obstruction and hypoplasia of pancreas is a very rare occurrence with evidence linking it to RFX6 gene mutation. The presence in newborn babies necessitates a detailed genetic evaluation and multidisciplinary management. Here, we present a preterm baby with persistent neonatal hyperglycemia and gastrointestinal anomalies similar to cases associated with Mitchel-riley/Martinez-frias syndrome.

Chronic oesophagocutaneous fistula formation as a complication of oesophagostomy tube placement in a dog

AbstractA 7‐year 6‐month‐old, male, neutered Shih Tzu had an oesophagostomy tube placed for nutritional support following surgery for management of extrahepatic biliary obstruction secondary to cholelithiasis. The oesophagostomy tube was removed 1 week following surgery, with no abnormalities noted. The dog re‐presented 7 months later with a persistent discharge at the previous stoma site. This was diagnosed as an oesophagocutaneous fistula following oesophagoscopy and ultrasound examination. The fistula was closed surgically, and the dog made a full recovery.

THU369 A Rare Case Of IgG4-related Autoimmune Pancreatitis And Diabetes Mellitus

Abstract Disclosure: M. Zahid: None. J. Shakil: None. Introduction: IgG4 related disease (IgG4-RD) is a rare multiorgan inflammatory condition characterized by dense lymphoplasmacytic infiltrates, presence of IgG4+ plasma cells and fibrosis. Here we present a case of young male with painless jaundice and hyperglycemia diagnosed with IgG4 related autoimmune pancreatitis and DM. Clinical Case: 46-year-old male with no significant history presented to outpatient clinic for pruritis and dark-colored urine of 2-week onset. He reported 17-pounds weight loss in the preceding month. While undergoing outpatient workup, patient developed epigastric pain prompting visit to the hospital. On examination, patient was afebrile, tachycardiac, icteric and had epigastric tenderness. Labs revealed normal electrolytes and renal function. LFTs were significant for total protein 7.6 g/dl (n=6.3-8.3 g/dl), AST 77 U/L (n = 10-50 U/L), ALT 127 U/L (n = 5-50 U/L), alkaline phosphatase 458 U/L (n = 40-129 U/L) and direct bilirubin >10.0 (n = 0-0.3 mg/dl). Lipase was 99 U/L (n - 13-60 U/L), blood glucose was 292 mg/dl and A1C was 6.5% (n = 4.0-5.6%). US abdomen revealed diffuse gallbladder wall thickening with moderate sludge and intrahepatic and extrahepatic distal biliary obstruction and dilatation. MRCP showed common bile duct and intrahepatic biliary ductal dilation. Pancreas was diffusely irregular with areas of hemorrhagic pancreatitis. ERCP showed dilatation of upper and middle third of main bile duct, left and right hepatic ducts and all intrahepatic branches with a stricture in distal bile duct. Biliary sphincterotomy and placement of temporary plastic biliary stent was performed and ampullary biopsies were taken. IgG4 level was checked due to suspicion for IgG4-RD and was 293 mg/dl (n: 1-123 mg/dl). Pathology revealed mucosa with epithelial reactive changes. CD138 stain showed several mature plasma cells within the inflammatory infiltrate. In addition, immunostain for IgG4 shows several IgG4 positive plasma cells forming small clusters confirming diagnosis of IgG4-RD. Post procedure, his abdominal pain and LFTs started improving. Patient was started on prednisone for IgG4-RD and insulin for persistent hyperglycemia. His prednisone dose was later tapered after starting methotrexate. Patient’s most recent LFTs have normalized except mildly elevated ALT and A1C improved to 6.2%. Conclusion: Autoimmune pancreatitis and cholangiopathy are the pancreatobiliary manifestation of IgG4-RD and most often present as painless jaundice mimicking pancreatic cancer. Endocrine insufficiency usually manifests as diabetes mellitus/pre-diabetes and may also lead to autoimmune hypophysitis and Reidel’s fibrosis. Other organ systems that may also get involved include lacrimal and salivary glands, lungs, kidneys, nervous system, and lymphatic/vascular system. Early recognition and ongoing surveillance are key to appropriate management of this condition. Presentation: Thursday, June 15, 2023

Clinical use of uncovered balloon-expandable metallic biliary stents for treatment of extrahepatic biliary tract obstructions in cats and dogs: 11 cases (2012-2022).

To describe the application of uncovered balloon-expandable metallic biliary stents for treatment of extrahepatic biliary obstructions (EHBOs) and the outcomes for dogs and cats treated for EHBO with this technique. Retrospective single institutional study. Eight dogs and three cats treated at the Veterinary Specialty Hospital of San Diego for EHBO between January 2012 and February 2022. Data collected from the medical records included signalment, presenting complaint, laboratory and imaging findings, surgical findings, hospitalization time, complications, and follow-up information. Median duration of short-term follow up was 16 days (6-45 days). Improved biochemical abnormalities and resolution of clinical signs were recorded in 10/11 cases. Two dogs died within 2 weeks of surgery. One dog developed systemic inflammatory response syndrome 5 days postoperatively and was euthanized; the cause of death in the second case was unknown. Long-term follow up was available in seven cases, with a median duration of 307.5 days (62-2268 days). Bile-duct patency was maintained for at least 356-622 days (median: 446 days) in three cats and 62-2268 days (median: 650.5 days) in four dogs with long-term follow up available. One cat had recurrent obstruction with choledocholiths 446 days postoperatively. One stent was removed 614 days postoperatively due to recurrent cholangiohepatitis. Uncovered balloon-expandable metallic biliary stents were placed successfully and relieved EHBO in all cases that survived to discharge. Use of uncovered balloon-expandable metallic biliary stents should be considered as an alternative to temporary choledochal luminal stenting or cholecystoenterostomy to manage EHBO.

Features, management, and long-term outcome in dogs with pancreatitis and bile duct obstruction treated medically and surgically: 41 dogs (2015-2021).

Pancreatitis resulting in extrahepatic biliary obstruction (EHBO) can cause substantial morbidity and mortality. Endoscopic retrograde cholangiopancreatography is utilized for diagnostic and therapeutic purposes in humans; however, this is not available in veterinary medicine. Treatment options include medical management and biliary drainage procedures. The aim of this study was to describe the management of EHBO secondary to pancreatitis in dogs, treated medically and surgically and to determine whether the neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) differ between the treatment groups. 41 dogs treated for EHBO secondary to pancreatitis during the period of May 2015 to November 2021. Records from 41 dogs diagnosed with EHBO secondary to pancreatitis were reviewed, and information extracted included clinical signs, ultrasound findings, NLR, PLR, histopathology, treatment, and outcomes. 18 of 19 (95%) surgical patients survived, while 12 of 21 (57%) medical patients survived. There was no difference in the length of hospitalization or time to return to adequate function between the groups; however, there was a significant difference in the 2- and 12-month survival between those treated surgically and medically. There was no difference in the NLR or PLR between surgically versus medically treated dogs or between survivors and nonsurvivors. The mortality rate of surgery for EHBO secondary to pancreatitis may be lower than previously described, and in this cohort of dogs, those treated surgically had improved survival at 2 and 12 months compared to those treated medically.

Risk factors for post-endoscopic retrograde pancreatography pancreatitis in malignant extrahepatic biliary obstruction: a retrospective single-center study

Background. Decompression interventions under the endoscopic retrograde cholangiopancreatography (ERCP) is the method of choice in malignant extrahepatic biliary obstruction (MEHBO). Acute pancreatitis is the most common complication of ERCP. Many studies have been performed to identify the risk factors for post-ERCP pancreatitis (PEP). However, these works in general include the analysis of ERCP in patients with various causes of biliary obstruction without subdividing patients with malignant obstruction.
 Purpose.The aim of this study was to determine the risk factors for PEP in patients with MEHBO.
 Materials and Methods. A retrospective analysis of 100 cases of ERCP in MEHBO was done. PEP was in 2 patients, and 14 patients had hyperamylasemia (HA). The following factors were analyzed: gender, age, level of MEHBO, obstruction of the main pancreatic duct (MPD), total bilirubin level, history of endoscopic papillosphincterotomy (EPST), periampullary diverticulum, successful ERCP, primary selective biliary cannulation, catheterization and/or contrast injection into MPD, Precut EPST, successful decompression.
 Results and discussion. Univariate analysis showed that PEP is associated with an obstruction at the level of the proximal and middle third of the hepaticocholedochus (p = 0.004) and with absence of MPD obstruction (p = 0.022); female gender (p = 0.012), obstruction at the level of the proximal and middle third of the hepaticocholedochus (p < 0.001), absence of MPD obstruction (p < 0.001), catheterization and/or contrast injection into MPD (p = 0.040) are associated with PEP or hyperamylasemia (HA); female gender (p = 0.024), obstruction at the level of the proximal and middle third of the hepaticocholedochus (p < 0.001), absence of MPD obstruction (p=0.006), catheterization and/or contrast injection into MPD (p = 0.035), successful decompression (p = 0.004) are associated with HA. Multivariate regression analysis showed that, for PEP and for PEP or HA as well as for HA, the risk factors are obstruction at the level of the proximal and middle third of the hepaticocholedochus (p = 0.005; p < 0.001; p < 0.001, respectively) and absence of MPD obstruction (p = 0.022; p < 0.001; p = 0.008, respectively). Female gender is a risk factor for PEP or HA and HA (p = 0.011; p = 0.028, respectively), and catheterization and/or contrast injection into MPD are risk factors for PEP or HA (p = 0.04). Conclusion. Development of PEP in MEHBO depends on the localization of a tumor and involvement of the pancreas. The risk factors for PEP in MEHBO are tumor localization at the level of the middle and proximal third of the hepaticocholedochus and absence of MPD obstruction.

Unusual Case of Biliary Peritonitis in a Dog Secondary to a Gastric Perforation

Biliary peritonitis is a pathological condition representing a medical emergency with a high risk of mortality. This condition is reported in both human and veterinary medicine following biliary tract rupture, extrahepatic biliary obstructions, gallbladder rupture, trauma, or duodenal perforation. In this report, the first-ever case of biliary peritonitis due to gastric perforation in a Bobtail purebred dog is described, which was probably induced by the administration of nonsteroidal anti-inflammatory drugs (NSAIDs). After an elective splenectomy and castration, the dog was referred to our hospital for medical management for inappetence, mental depression, and multiple episodes of gastric vomits with traces of blood. Clinical diagnostic tests showed the presence of biliary peritonitis. Due to worsening clinical conditions, the patient was subjected to euthanasia. Macroscopic examination showed a free brownish abdominal effusion and the presence of perforating ulcer of the stomach pylorus region.

Effect of radiofrequency ablation in addition to biliary stent on overall survival and stent patency in malignant biliary obstruction: an updated systematic review and meta-analysis.

Radiofrequency ablation (RFA) is used in addition to stent placement to manage extrahepatic malignant biliary obstruction. We aimed to study the effect of RFA on overall survival (OS) and stent patency in malignant biliary obstruction. A comprehensive literature search was performed from inception to May 2022 for all studies measuring the effect of RFA plus stents compared to stents placement only on OS and stent patency in patients with malignant biliary obstruction. We measured differences in OS, stent patency, and odds of adverse events. A random effect model was used to pool data for stent patency, OS, and adverse event. A total of 17 studies (14 observational and 3 RCT) containing 1766 patients were included in the analysis. The weighted pooled mean survival difference was 58.5 days [95% confidence interval (CI): 32.6-84.4, I2 = 71%] in favor of the RFA treatment group. The weighted mean difference in stent patency was better in the RFA plus stent group by 45.3 days (95% CI: 30.1-60.5, I2 = 16.4%) compared to stent only group. The pooled odds of adverse events were the same in both groups [odds ratio (OR) 1.52, 95% CI: 0.96-2.43, I2 = 59%], and no serious adverse event was seen in either group, or no death reported secondary to RFA procedure. No difference in stent patency based on procedure type, including percutaneous transhepatic cholangiography versus endoscopic retrograde cholangiopancreatography (P = 0.06), and an underline cause of bile duct obstruction was found (P = 0.261). RFA treatment, in addition to stent placement in malignant biliary obstruction, potentially improves OS and stent patency duration.

Society of Gastrointestinal Endoscopy of India Consensus Guidelines on Endoscopic Ultrasound-Guided Biliary Drainage: Part II (Technical Aspects)

AbstractEndoscopic management of bile duct obstruction is a key aspect in gastroenterology practice and has evolved since the first description of biliary cannulation by McCune et al in 1968. Over many decades, the techniques and accessories have been refined, and currently, the first-line management for extrahepatic biliary obstruction is endoscopic retrograde cholangiopancreatography (ERCP). However, even in expert hands, the success rate of ERCP reaches up to 95%. In almost 4 to 16% cases, failure to cannulate the bile duct may necessitate other alternatives such as surgical bypass or, more commonly, percutaneous transhepatic biliary drainage (PTBD). While surgery is associated with high morbidity and mortality, PTBD has a very high reintervention and complication rate (∼80%) and poor quality of life. Almost parallelly, endoscopic ultrasound (EUS) has come a long way from a mere diagnostic tool to a substantial therapeutic option in various pancreaticobiliary diseases. Biliary drainage using EUS-guidance (EUS-BD) has gained momentum since the first report published by Giovannini et al in 2001. The concept of accessing the bile duct through a different route than the papilla, circumventing the shortcomings of PTBD, and sometimes bypassing the actual obstruction have enthused a lot of interest in this novel strategy. The three key methods of EUS-BD entail transluminal, antegrade, and rendezvous approach. Over the past decade, with growing experience, EUS-BD has been found to be equivalent to ERCP or PTBD for malignant obstruction with better success rates. EUS-BD, however, is not devoid of adverse events and can carry fatal adverse events. However, neither the technique of EUS-BD nor the accessories and stents for EUS-BD have been standardized. Additionally, different countries and regions have different availability of the accessories, making generalizability a difficult task. Thus, technical aspects of this evolving therapy need to be outlined. For these reasons, Society of Gastrointestinal Endoscopy of India (SGEI) deemed it appropriate to develop technical consensus statements for performing safe and successful EUS-BD.

Efficacy Analysis of Suprapapillary versus Transpapillary Self-Expandable Metal Stents According to the Level of Obstruction in Malignant Extrahepatic Biliary Obstruction.

The use of a self-expandable metal stent (SEMS) is recommended for unresectable malignant biliary obstruction (MBO). Stent-related adverse events might differ according to the position of the stent through the ampulla of Vater (AOV). We retrospectively evaluated SEMS patency and adverse events according to the position of the SEMS. In total, 280 patients who underwent endoscopic SEMS placement due to malignant distal biliary obstruction were analyzed retrospectively. Suprapapillary and transpapillary SEMS insertions were performed on 51 patients and 229 patients, respectively. Between the suprapapillary group (SPG) and transpapillary group (TPG), the stent patency period was not significantly different (median [95% confidence interval]: 107 days [82.3 to 131.7] vs 120 days [99.3 to 140.7], p=0.559). There was also no significant difference in the rate of adverse events. In subgroup analysis, the stent patency for an MBO located within 2 cm from the AOV was found to be significantly shorter than that for an MBO located more than 2 cm from the AOV in the SPG (64 days [0 to 160.4] vs 127 days [82.0 to 171.9], p<0.001) and TPG (87 days [52.5 to 121.5] vs 130 [97.0 to 162.9], p<0.001). Patients with an MBO located within 2 cm from the AOV in both groups had a higher percentage of duodenal invasion (SPG: 40.0% vs 4.9%, p=0.002; TPG: 28.6% vs 2.9%, p<0.001) than patients with an MBO located more than 2 cm from the AOV. The SPG and TPG showed similar results in terms of stent patency and rate of adverse events. However, patients with an MBO located within 2 cm from the AOV had a higher percentage of duodenal invasion with shorter stent patency than those with an MBO located more than 2 cm from the AOV, regardless of stent position.

A new index for predicting malignant causes in patients with extrahepatic biliary obstruction: the hemoglobin, albumin, lymphocyte, and platelet (HALP) score.

The study aimed to investigate whether the pre-procedural hemoglobin, albumin, lymphocyte, and platelet (HALP) scores can distinguish between benign and malignant causes of obstruction in patients who undergo endoscopic retrograde cholangiopancreatography (ERCP) for extrahepatic biliary obstruction (EBO). The HALP scores of the patients were calculated according to the values before ERCP. The patients were divided into two groups as malignant and benign according to their diagnosis after ERCP. The HALP scores, demographic characteristics, and some laboratory data of the groups were compared. The cut-off values of the HALP scores were found to detect malignant obstructive causes using the receiver operating characteristic (ROC) curve analysis. A total of 295 patients had benign and 50 had malignant causes of obstruction among the total of 345 patients. The HALP score was found to be lower in the patient group with malignant biliary obstruction (p = 0.013). The ROC curve analysis was used to determine the diagnostic efficiency, and an area under the curve (AUC) of 0.610 was obtained (0.526-0.693, 95% CI) (p = 0.013). For the HALP score, the sensitivity was found to be 82.4% and the specificity was 30% when a cut-off value of <12.54 was used, and the sensitivity was 61.4% and specificity was 52% when the cut-off value was <21.25. The study showed that a low HALP score can distinguish malignant causes in patients with EBO. We think that the HALP score, which is a low-cost index that can be easily calculated with simple tests, can be used in this patient population because it may allow early diagnosis of malignant causes in patients with EBO.

Preliminary exploration of the efficacy of laparoscopic fluorescence cholangiography (LFC) in the diagnosis of biliary atresia compared with intraoperative cholangiography (IOC).

Intraoperative cholangiography (IOC) has been the gold standard for diagnosing biliary atresia (BA). Our study attempted to diagnose BA using laparoscopic fluorescein cholangiography (LFC). We retrospectively included 18 patients with preoperative suspected BA as the case group and 4 without extrahepatic biliary obstruction requiring laparoscopic surgery as the control group. All patients received indocyanine green (ICG) intravenously at 0.05mg/Kg. The first 6 patients in the case group underwent IOC and LFC simultaneously, and the control group completed LFC. The imaging characteristics of LFC were recorded and summarized by the conventional and fluorescence mode of the endoscopic fluorescence imaging system (DPM-ENDOCAM-03). On this basis, 12 patients in the case group were diagnosed as BA according to LFC without IOC, and all 18 patients completed open Kasai surgery to confirm the diagnosis. Laparoscopic fluorescence mode in BA detected liver fluorescence but no visualization of the extrahepatic bile ducts. However, the extrahepatic bile ducts in the control group were visible. Based on the imaging characteristics summarized from the LFC of the first 6 cases with BA in the case group, the remaining 12 cases who only underwent LFC were also successfully diagnosed with BA. Furthermore, the formation of hepatic hilar fibrous mass was found in all the patients during the open Kasai procedure, which confirmed the BA diagnosis. LFC appears as a specific pattern in BA and may be used for intraoperative diagnosis of BA. It has the advantages of simplicity, short time-consuming, and no radiation damage.

Society of Gastrointestinal Endoscopy of India Consensus Guidelines on Endoscopic Ultrasound-Guided Biliary Drainage: Part I (Indications, Outcomes, Comparative Evaluations, Training)

AbstractEndoscopic management of bile duct obstruction is a key aspect in gastroenterology practice and has evolved since the first description of biliary cannulation by McCune et al in 1968. Over many decades, the techniques and accessories have been refined and currently, the first-line management for extrahepatic biliary obstruction is endoscopic retrograde cholangiopancreaticography (ERCP). However, even in expert hands the success rate of ERCP reaches up to 95%. In almost 4 to 16% cases, failure to cannulate the bile duct may necessitate other alternatives such as surgical bypass or more commonly percutaneous transhepatic biliary drainage (PTBD). While surgery is associated with high morbidity and mortality, PTBD has a very high reintervention and complication rate (∼80%) and poor quality of life. Almost parallelly, endoscopic ultrasound (EUS) has come a long way from a mere diagnostic tool to a substantial therapeutic option in various pancreatico-biliary diseases. Biliary drainage using EUS-guidance (EUS-BD) has gained momentum since the first report published by Giovannini et al in 2001. The concept of accessing the bile duct through a different route than the papilla, circumventing the shortcomings of PTBD and sometimes bypassing the actual obstruction have enthused a lot of interest in this novel strategy. The three key methods of EUS-BD entail transluminal, antegrade, and rendezvous approach. Over the past decade, with growing experience, EUS-BD has been found to be equivalent to ERCP or PTBD for malignant obstruction with better success rates.EUS-BD, albeit, is not devoid of adverse events and can carry fatal adverse events. However, neither the technique of EUS-BD, nor the accessories and stents for EUS-BD have been standardized.Additionally, different countries and regions have different availability of the accessories making generalizability a difficult task. Thus, technical aspects of this evolving therapy need to be outlined. For these reasons, the Society of Gastrointestinal Endoscopy India deemed it appropriate to develop technical consensus statements for performing safe and successful EUS-BD.

Dietary Fat Exacerbates Liver Disease in Bile Duct-Ligated Rats

Previous studies have suggested that the mortality of bile duct-ligated (BDL) rats is related to the amount of dietary fat consumed. We investigated the influence of dietary fat concentration on liver disease in BDL rats. Groups of rats were fed for 4 wk either a low fat diet (LF, 0.92 kJ/g; 3% of total energy from fat), a high fat diet (HF, 1.07 kJ/g; 30% fat), a high fat diet with energy density equivalent to that of the LF diet (HFIB, 0.92 kJ/g; 30% fat) or a diet based on the composition of commercial nonpurified diets (COMP, 0.90 kJ/g; 10% fat). Energy intake, body weight gain, plasma biochemical indices and hepatic histology were compared in BDL and sham-operated control rats. Bile duct-ligated animals consuming the LF diet showed a faster recovery of energy intake and greater body weight gain following surgery than did BDL animals fed the other three diets. Plasma alkaline phosphatase activity was significantly greater in BDL animals fed either of the high fat diets than in those fed the LF or COMP diet starting 1 and 2 wk, respectively, after surgery. Hepatic fibrosis and bile duct proliferation at d 28 post-ligation were greater in rats fed a 30% fat (HF) diet than in rats fed the 3% fat (LF) diet. These results suggest that dietary fat concentration can influence the severity of liver dysfunction in extrahepatic biliary obstruction.

A Case of Erdheim-Chester Disease Causing Secondary Sclerosing Cholangitis

Erdheim-Chester disease (ECD) is an exceedingly rare and aggressive disease characterized by foamy CD68 + CDa-histiocytic infiltration into multiple tissues and organs. Only 1,500 cases have been diagnosed since 1930 when ECD was first described. Biliary tract involvement of ECD has only been reported in the literature once. We report a case of ECD causing extrahepatic biliary obstruction without significant bile duct dilation, mimicking primary sclerosing cholangitis or IgG4 disease.

Capsulation of EBTAC into ZIF-8 for the development of a signal-on fluorescent biosensor to detect alkaline phosphatase.

Diseases such as liver cancer, extrahepatic biliary obstruction and osteocarcinoma are closely associated with the abnormal level of alkaline phosphatase (ALP). Hence, it is essential to develop a convenient assay to detect ALP activity. Herein, a novel signal-on fluorescent biosensor on account of the fluorescence signal of the aggregation-induced emission (AIE) fluorochrome 2,2',2'',2'''-((ethene-1,1,2,2-tetrayltetrakis(benzene-4,1-diyl))tetrakis(oxy))tetraacetic acid (EBTAC) encapsulated zeolitic imidazolate framework-8 (ZIF-8@EBTAC) was designed to monitor ALP. Due to the aggregation-induced emission of EBTAC, the synthetic ZIF-8@EBTAC shows robust fluorescence. Once pyrophosphate (ppi) was added, its complexation with Zn2+ in ZIF-8 triggered the collapse of the ZIF-8 framework, releasing encapsulated EBTAC molecules and restoring to free state, leading to the dramatical decrease in fluorescence. ALP could catalyze the hydrolysis of ppi to phosphate (pi), which is difficult to bind to Zn2+ and has little effect on the fluorescence of ZIF-8@EBTAC. Therefore, with the assistance of the substrate ppi, the ultimate fluorescence of ZIF-8@EBTAC was positively related with ALP activity. The constructed biosensor was able to monitor the ALP activity well from 0.01 to 100 U L-1, and a detection limit of 0.01 U L-1 was achieved. Based on the ability of EBTAC serving as a fluorescent probe with aggregation-induced luminescence properties, this proposed design can be applied to diverse targets and provide new ideas for the establishment of fluorescent biosensors.

Hepatocellular-Cholangiocarcinoma Collision tumor (cHCC-CC) manifesting as Extrahepatic biliary obstruction: A case report

Hepatocellular-Cholangiocarcinoma Collision tumor (cHCC-CC) manifesting as Extrahepatic biliary obstruction: A case report

Induction of Obstructive Cholestasis in Mice.

Experimental bile duct ligation (BDL) in rodents causes cholestatic liver injury characterized by structural and functional alterations that include periportal biliary fibrosis. These changes are time-dependent and based on excess accumulation of bile acids in the liver. This in turn causes damage of hepatocytes and functional loss, leading to recruitment of inflammatory cells. Liver resident pro-fibrogenic cells facilitate extracellular matrix synthesis and remodeling. The proliferation of bile duct epithelial cells provokes a ductular reaction characterized by bile duct hyperplasia. Experimental BDL surgery is technically simple and quick to perform and reliably generates progressive liver damage with a predictable kinetics. The cellular, structural, and functional alterations induced in this model are similar to that in humans suffering from diverse forms of cholestasis including primary biliary cirrhosis (PBC) or primary sclerosing cholangitis (PSC). Therefore, this extrahepatic biliary obstruction model is used in many laboratories worldwide. Nevertheless, BDL can result in significant variations and high mortality rates when surgery is carried out by untrained or inexperienced personnel. Here we present a detailed protocol to achieve a robust experimental obstructive cholestasis in mice.