Bile duct injury (BDI) following the widely performed laparoscopic cholecystectomy (LC) remains a serious complication. Its incidence ranges from approximately 0.32% to 0.8%, but the actual incidence may be higher due to variations in statistical conditions. BDI not only impairs patients’ quality of life but may also shorten their lifespan. Numerous preventive measures for BDI are available, including critical view of safety (CVS), intraoperative cholangiography (IOC), indocyanine green fluorescent cholangiography (ICG-C), artificial intelligence model assistance, and subtotal cholecystectomy. Each method has its own applicable cases, advantages, and disadvantages. Various classification systems exist for BDI, yet no unified standard has been established. Only the Bismuth-Strasberg Type E injury has gained relatively high recognition, and there is little significance in reluctantly classifying non-immediate injuries. Treatment methods include endoscopic/interventional therapy and surgical procedures such as repair, end-to-end anastomosis, choledochojejunostomy, hepatectomy, and liver transplantation. The treatment of BDI emphasizes early repair by specialized surgeons in well-equipped hospitals using microsurgical techniques. Post-repair follow-up is required for at least 3 to 5 years. Additionally, it is important to note that BDI is frequently accompanied by concomitant vascular injury and is prone to complications such as bile leakage. Delayed repair is associated with a poorer prognosis.
Post-cholecystectomy abdominal pain (PCAP) is a common and intractable clinical problem. Its etiology is complex, involving organic and functional factors, which often leads to a complex diagnosis process and unsatisfactory treatment effect. Breaking through the traditional vague concept of “post-cholecystectomy syndrome”, it should be regarded as a clinical problem requiring active exploration of specific etiologies, and a set of hierarchical and visual diagnostic mind maps should be constructed, the core of which is to comprehensively identify the main etiologies, such as sphincter of Oddi dysfunction (SOD), organic biliary tract diseases, postoperative digestive dysfunction and abdominal myofascial pain syndrome, start with the detailed medical history collection and early warning sign identification for risk stratification and pathway triage of patients, emphasize the standardized classification and management of SOD based on the Rome Criteria, avoid the invasive treatment for type Ⅲ SOD, and pay more attention to the overlap with irritable bowel syndrome (IBS) and functional dyspepsia (FD).
The 16th International Gastric Cancer Congress (IGCC 2025) was successfully held in Amsterdam, Netherlands in May 2025, bringing together leading global experts in gastric cancer research. Through diverse formats including oral presentations, poster exhibitions, and specialized symposiums, the congress facilitated in-depth discussions on the latest advancements and future trends in the field of gastric cancer. Chinese scholars demonstrated outstanding performance at this congress, with 21 high-quality oral presentations fully showcasing the academic influence of Chinese research teams in gastric cancer. Through the establishment of a systematic clinical research framework, Chinese teams have not only contributed to the development minimally invasive surgery and perioperative management for gastric cancer but have also proposed innovative solutions in cutting-edge fields such as immunotherapy and targeted therapies. The main contents of IGCC 2025 also include the diversified global landscape of gastric cancer management, clinical practice and evidence-based exploration of robotic surgery, trends in gastric cancer database construction and data sharing, as well as diagnostic and therapeutic innovations driven by artificial intelligence and multidisciplinary integration.
Traditionally viewed as a passive conduit, the biliary system is now recognized as a highly coordinated hydraulic “pump-conduit-valve” system with intricate biomechanical properties. Biomechanical alterations in the biliary tract are not merely consequences of disease but are key driving factors in its pathogenesis and progression. The mechanism of solid and fluid mechanics in benign biliary diseases encompasses biliary geometry, sphincter of Oddi dynamics, the mechanical properties of the gallbladder and bile ducts, bile composition and rheological behavior, and their interplay in stone formation and inflammatory development. The application prospects of biliary biomechanics in clinical diagnosis and treatment include patient-specific simulations based on computational fluid dynamics, functional reconstruction in surgical procedures, and the development of novel pharmaceuticals and stents. In the future, multidisciplinary integration will advance biliary biomechanics from mechanistic research to clinical translation, offering new avenues for precise and radical management of benign biliary diseases.
The sphincter of Oddi plays a crucial role in maintaining the function of biliary tract. In the surgical management of benign biliary diseases, the injury of sphincter of Oddi limited both the surgical outcomes and long-term prognosis for patients with benign biliary diseases. However, many challenges remain in the assessment of Oddi sphincter function, surgical management, and other related aspects. At present, there are no precise methods for evaluating the function of the sphincter of Oddi or effective ways to restore its function. Therefore, two strategies are often adopted to avoid or mitigate the sphincter of Oddi impairment: surgical approaches and operation techniques that better preserve its function with the aim of improving the long-term prognosis of patients.
Biliary dilatation (BD) is a benign biliary disorder characterized by cystic or fusiform dilation of the intra- and extra-hepatic bile ducts, with a higher prevalence in East Asian populations and among females. The pathogenesis is primarily associated with pancreaticobiliary maljunction (PBM). Clinical presentation is highly variable, and diagnosis relies on imaging including ultrasound, CT, and MRCP. Surgical resection remains the curative treatment, emphasizing complete excision of the diseased bile ducts and biliary reconstruction. Key challenges include the management of the intrapancreatic bile duct, accurate intraoperative determination of the extent of involvement, and individualized surgical strategies. Although surgery significantly reduces the risk of complications and malignancy, patients remain at lifelong risk for long-term complications, necessitating a lifelong and multidisciplinary long-term follow-up system to monitor complications and malignant transformation.
Polypoid lesions of gallbladder (PLG) are common benign gallbladder diseases. Although current domestic and international guidelines have reached consensus on using ultrasonography as the primary diagnostic approach, stratification of malignant risk, and generally adopting a diameter of ≥10 mm as the basic surgical threshold, certain controversies persist regarding the definition of surgical indications and follow-up management strategies. Problems and challenges include difficulties in preoperative differentiation, unclear management of low-risk polyps, and potential unnecessary surgeries. Currently, individualized assessment has become key to balancing “over-treatment” and “missed diagnosis of malignancy,” necessitating dynamic monitoring and intervention based on risk stratification to enhance the precision of PLG diagnosis, treatment, and follow-up management. With advancements in technologies such as artificial intelligence, the precision medicine system for PLG is expected to be progressively refined in the future.
Management strategies for asymptomatic gallstones in China differs from that of other countries. The international, mainstream guidelines advocate watchful waiting, while Chinese recommendations favor prophylactic cholecystectomy due to the high burden of gallbladder cancer. The core reason for this debate lies in balancing the immediate risks of surgery against the long-term risk of malignancy. Implementing a risk stratification system, coupled with dynamic re-assessment, is crucial for enabling personalized precision intervention. Future efforts should focus on transitioning from population-based guidelines to individualized care, ensuring timely intervention for high-risk populations.
Intraductal papillary neoplasm of bile duct (IPNB) is a rare biliary tract tumor, and possesses a potential for malignancy. Its clinical manifestations are often insidious, with patients frequently presenting initially with jaundice, right upper quadrant pain, or weight loss. Due to its atypical presentation, it is easily misdiagnosed as cholangitis or cholelithiasis. Currently, surgical resection of the lesion is the primary treatment of choice, followed by regular postoperative surveillance for recurrence monitoring. For patients ineligible for surgery, endoscopic biliary drainage or palliative chemoradiotherapy may be considered to alleviate symptoms and delay disease progression. In recent years, advancements in imaging techniques and deeper pathological understanding have improved the preoperative diagnostic rate of IPNB; however, differential diagnosis remains challenging.
Complex benign biliary diseases have a high recurrence rate, with persistent symptoms and a high probability of requiring further surgery. Multiple surgeries can lead to secondary complications such as abdominal infection, biliary fistula, digestive tract fistula, liver cirrhosis, and bile duct stones, seriously endangering the patient’s health. Reoperation is far more complex, difficult, time-consuming, and has a higher complication rate than the first operation. Therefore, precise preoperative assessment, thorough preparation, well-considered decision-making, and precise control of the operation timing are all indispensable important factors for safe and successful reoperation. During the operation, appropriate surgical methods should be adopted, precise separation and identification of anatomical structures, especially hepatic and biliary vascular structures, should be carried out, and meticulous operation should be performed, to reduce injury and protect healthy liver tissue. At the same time, perioperative management and postoperative comprehensive treatment methods should be comprehensively improved to improve the clinical efficacy of reoperation for complex benign biliary diseases, reduce postoperative recurrence and complications.
Objective To evaluate the effectiveness of stratified surgical approaches for gallbladder diseases based on malignancy risk. Methods Retrospectively analyze the clinical data of 2888 patients who underwent surgery for gallbladder diseases at Mengchao Hepatobiliary Hospital of Fujian Medical University between January 2015 and June 2025. Patients were categorized into four groups: standard laparoscopic cholecystectomy (n=1831), laparoscopic cholecystectomy with intraoperative frozen section (IFS; n=996), middle hepatectomy plus cholecystectomy with IFS (n=24), and radical cholecystectomy (n=37). Clinical characteristics, pathology, perioperative outcomes, and long-term survival were compared. Results The incidence of gallbladder cancer (GBC) in the cholecystectomy group, the cholecystectomy with IFS group, the middle hepatectomy plus cholecystectomy with IFS group and the radical cholecystectomy group were 0.4%, 1.4%, 29.2%, and 81.1%, respectively. The spectrum of benign lesions exhibits significant differences. Benign lesions in the middle hepatectomy plus cholecystectomy with IFS group and the radical cholecystectomy group primarily included entities radiologically indistinguishable from malignancy, such as xanthogranulomatous cholecystitis and benign gallbladder tumors. In diagnostically challenging cases, IFS demonstrated higher accuracy than preoperative imaging (97.3% vs. 75.5%, P<0.05). AJCC staging distributions differed significantly among groups (P=0.011). In the cholecystectomy group, 7 incidental GBC cases were identified, 5 cases (71.4%) of which were Stage 0-Ⅱ, compared with only 16.7% in the radical cholecystectomy group. Patients with Stage 0-Ⅱ disease had superior 1, 3, and 5 year overall and disease-free survival compared with Stage Ⅲ-Ⅳ disease, with statistically significant differences (both P<0.05). However, median survival did not differ significantly among surgical approaches in GBC patients (P>0.05). Conclusion Surgical strategies for gallbladder diseases should be guided by malignancy risk stratification. In cases with indeterminate imaging or suspicious intraoperative findings, IFS is essential for distinguishing benign from malignant lesions and informing surgical escalation. Combining IFS offers a balanced approach, providing an effective and safe option for patients with suspected GBC.
Objective To investigate the effects of different doses and administration times of indocyanine green (ICG) in the visualization of extrahepatic bile ducts during daytime laparoscopic cholecystectomy (DSLC). Methods A total of 800 patients who underwent DLC surgery at Beijing Friendship Hospital of Capital Medical University (639 cases), Civil Aviation General Hospital (45 cases), Changping District Hospital of Beijing (34 cases), and Xuanwu Hospital of Capital Medical University (82 cases) between January 2023 and December 2024 were prospectively included. The patients were intravenously injected with four different doses of ICG (2, 4, 8, and 16 μg/kg) 30 minutes before the operation. The fluorescence intensity of the common bile duct and liver at three time points during the operation (before the free gallbladder triangle area, after the free gallbladder triangle area, and after the disconnection of the gallbladder neck tube) and the bile duct-liver fluorescence ratio (BLR) at these three time points were evaluated. Results The 800 patients were randomly divided into four groups using a random number generation method. Finally, 784 patients were included in the analysis, including 198 cases in the 2 μg/kg group, 196 cases in the 4 μg/kg, 198 cases in the 8 μg/kg, and 192 cases in the 16 μg/kg. There was no statistically significant difference in the baseline characteristics of the patients among the four groups (P>0.05). The fluorescence intensity of the bile duct and liver in 2 μg/kg group was smaller, while the fluorescence intensity of the bile duct and liver background in 16 μg/kg group was higher at the three time points. Strong fluorescence intensity was observed in the bile duct of 4 μg/kg group, and the fluorescence intensity of the liver background was lower. With the increase in ICG dose, the fluorescence intensity of the liver background (F=2.416, P=0.133) and bile duct (F=4.205, P=0.031) at three time points gradually increased. The BLR did not show a significant upward trend with the increase in ICG dose (P=0.113). The average BLR of 4 μg/kg group was higher than that of groups 2, 8, and 16 μg/kg group, and the difference was statistically significant (2.12 vs. 1.18 vs. 1.49 vs. 1.32, P=0.005). Conclusion For daytime fluorescence laparoscopic cholecystectomy, intravenous injection of 4 μg/kg of ICG 30 minutes before the operation is an appropriate scheme for real-time fluorescence biliary imaging.
Objective To evaluate the preliminary application of lateral approach single-incision laparoscopic totally extraperitoneal (L-SILTEP) repair for the surgical treatment of parastomal hernia. Methods The clinical data of 14 parastoma hernia patients who underwent L-SILTEP at the First Affiliated Hospital of Ningbo University, Shanghai General Hospital affiliated to Shanghai Jiao Tong University School of Medicine, and Shanghai East Hospital affiliated to Tongji University between June 2021 and March 2025 were analyzed retrospectively. The clinical data included preoperative baseline data as well as intraoperative and postoperative conditions. Results All operations were successfully completed without conversion to open surgery. The mean age of the patients was (70.36±9.04) years, and the body mass index (BMI) was 23.16±3.85. The median operative time was 192 (160.25, 220.75) minutes. The mean intraoperative blood loss was 10 (10, 20) mL, and no intraoperative complications occurred. The mean visual analogue scale (VAS) scores at 6 hours, 24 hours, and 48 hours after surgery were (3.79±0.89) points, (2.36±0.84) points, and (1.21±0.43) points, respectively. The time to resume oral intake was (25.29±8.45) hours, the duration of drainage tube indwelling was (2.14±0.86) days, and the mean length of hospital stay was (6.21±1.42) days. No relevant complications were observed during the postoperative follow-up. Conclusion The short-term outcomes of applying L-SILTEP in parastomal hernia repair are satisfactory. However, it demands high technical proficiency. Therefore, surgical details must be emphasized, and the procedure should be conducted with prudence.
Objective To evaluate the therapeutic efficacy of postoperative adjuvant transarterial chemoembolization (TACE) in hepatocellular carcinoma (HCC) patients with satellite nodules after curative resection. Methods A retrospective analysis was performed on clinical data of 107 HCC patients with satellite nodules who underwent curative hepatectomy at the First Affiliated Hospital of the University of Science and Technology of China between January 1, 2018, and January 1, 2024. 51 patients underwent hepatectomy alone (control group), and 56 patients received postoperative adjuvant TACE (TACE group). The log-rank test was used to compare recurrence-free survival (RFS) and overall survival (OS) between groups. Cox regression analyses were applied to identify prognostic factors for RFS and OS, and univariate Cox proportional hazards models were used for subgroup analyses of RFS and OS. Results The median RFS duration in the TACE group was longer than that in the control group [14.72 (95%CI 9.49-27.96) months vs. 5.72 months (95%CI 4.40-9.53), P=0.006], with a 45.0% reduction in recurrence risk (HR=0.550, 95%CI 0.358-27.96). The 1- and 2-year RFS rates in the TACE group were 55.36% and 28.57%, respectively, compared to 29.41% and 11.76% in the control group. The median OS of the TACE group was longer than that in the control group (P=0.034), with a 48.4% reduction in mortality risk (HR=0.516, 95%CI 0.276-0.962）, At the end of follow-up, the median OS had not been reached in the TACE group, whereas it was 69.88 months (95%CI 22.14-NR) in the control group.Multivariate Cox analysis indicated that Edmondson-Steiner grade Ⅲ/Ⅳ (HR=1.82, 95%CI 1.11-2.96, P=0.017) and postoperative adjuvant TACE (HR=0.45, 95%CI 0.28-0.72, P<0.001) were independent prognostic factors for RFS. Alpha-fetoprotein >400 μg/L (HR=2.05, 95%CI 1.09-3.83, P=0.025), Edmondson-Steiner grade Ⅲ/Ⅳ (HR=2.28, 95%CI 1.20-4.31, P=0.012), and postoperative adjuvant TACE (HR=0.43, 95%CI 0.22-0.82, P=0.011) were independent prognostic factors for OS. Pain and elevated transaminase levels were the most common adverse effects in the TACE group, generally mild and manageable. Conclusion Postoperative adjuvant TACE can effectively prolong early recurrence-free survival and overall survival in HCC patients with satellite nodules.
Objective To comprehensively evaluate the long-term trends in surgical intervention and clinical outcomes of infected pancreatic necrosis (IPN). Methods Clinical data of 418 consecutive IPN patients admitted to Xiangya Hospital, Central South University, between January 2010 and December 2024 were prospectively collected. Based on the surgical intervention strategy, patients were divided into a step-up group (n=356) and a step-down group (n=62). The clinical data of the two groups were compared, and the trends in surgical strategies, operative approaches, and clinical outcomes over the 15-year period were analyzed. Results The overall mortality rate of patients was 24.4%. Compared to the step-down group, the step-up group demonstrated a significantly higher mean frequency of total surgical interventions, percutaneous catheter drainage (PCD) procedures, and minimally invasive retroperitoneal pancreatic necrosectomy (MARPN) procedures, but a lower mean frequency of open pancreatic necrosectomy (OPN) procedures (all P<0.05). Cox proportional hazards regression analysis identified multiple organ failure, timing of the first surgical intervention, step-up intervention strategy, frequency of surgical interventions, frequency of MARPN procedures, frequency of OPN procedures, and bleeding as independent influencing factors for mortality (all P<0.05). Trend analysis across three time periods (2010-2014, 2015-2019, 2020-2024) revealed a significant increase in the application rate of the step-up strategy among all patients (P for trend <0.05). Within both the step-up and step-down groups, the utilization rate of MARPN showed a significant increasing trend (P for trend <0.05). Conversely, the application rates of PCD and OPN in the step-up group exhibited significant decreasing trends (P for trend <0.05). Regarding clinical outcomes, the step-up group had significantly lower incidences of enteric fistula, bleeding, mortality, and shorter mean ICU and total hospital stays compared to the step-down group (all P<0.05). Furthermore, within the step-up group, the rates of pancreatic fistula, mortality, and mean ICU and total hospital stay demonstrated significant downward trends over time (P for trend <0.05). Survival analysis indicated a significantly higher long-term survival rate in the step-up group (P<0.05). Conclusion Over study period, the step-up strategy and MARPN have become the mainstay therapeutic approaches for IPN, which accounts for reduced complications and improved outcomes.
Objective To investigate the risk factors affecting clinical outcomes after pancreatic trauma surgery and to develop a model for predicting the probability of prolonged hospitalization. Methods A retrospective analysis was performed on the medical records of 76 patients with pancreatic trauma who underwent surgical treatment at the First Affiliated Hospital of Air Force Medical University between December 2009 and December 2024. The median length of hospital stay (LOS) was calculated using the Kaplan-Meier method. Multivariate Cox regression analyses were subsequently employed to identify independent predictors, based on which a nomogram was constructed. Time-dependent receiver operating characteristic curve area (tdAUC) and calibration curves were used to evaluate the model’s discrimination and calibration, respectively, at different time points. Results The median LOS for all patients was 15 (95%CI 13-27) d. Multivariate Cox regression analysis identified AAST grade Ⅳ/Ⅴ (HR=0.473, 95%CI 0.257-0.870, P=0.016) and combined hollow viscus rupture (HR=0.421, 95%CI 0.196-0.904, P=0.026) as independent risk factors for recovery and discharge. Conversely, serum albumin (ALB) level was an independent protective factor (HR=1.061, 95%CI 1.013-1.110, P=0.011). A nomogram was constructed to predict the probability of remaining hospitalized at 15, 30, and 40 days postoperatively. The time-dependent area under the curve (tdAUC) values for these time points were 0.860 (95%CI 0.771-0.948), 0.837 (95%CI 0.727-0.948), and 0.762 (95%CI 0.581-0.944), respectively. Internal validation with 1,000 bootstrap resamples demonstrated good agreement between the nomogram’s predictions and actual observations, as shown by the calibration curves. The optimal cut-off value for the nomogram score was determined to be 87.8. Conclusion The nomogram, incorporating AAST classification, presence or absence of hollow viscus rupture, and ALB level, can early and reliably predict the hospitalization probability of patients at different postoperative time points, facilitating early risk stratification. It helps clinicians identify patients at high risk for delayed discharge and provides a reference basis for postoperative refined management and optimal allocation of healthcare resources.
Objective To evaluate the safety and feasibility of colorectal cancer (CRC) surgery in patients with reduced left ventricular ejection fraction (LVEF) by comparing postoperative risks and long-term outcomes with those having preserved LVEF. Methods This retrospective study was conducted based on the clinical data of 41 patients with reduced LVEF and 135 patients with preserved LVEF who underwent CRC surgery at Department of Gastrointestinal Surgery, Guangdong Provincial People’s Hospital between May 2008 and December 2019. Propensity score matching (PSM) was used to balance the covariates between the groups. After PSM, 37 patients were included in the reduced LVEF group and 65 in the preserved LVEF group. The primary outcomes were overall survival and recurrence-free survival rates, and the secondary endpoints were perioperative data. Results After PSM, the estimated overall survival rates were 40.5% in the reduced LVEF group and 63.1% in the normal LVEF group, while the estimated recurrence-free survival rates were 36.1% and 58.7%, respectively. There were no statistically significant differences in overall survival rate and recurrence-free survival rate between the two groups (P>0.05). Subgroup analysis by tumor stage showed no statistically significant differences in survival rates between the two subgroups (P>0.05). After PSM, there were no statistically significant differences between the two groups in the proportion of stoma selection, surgical complications, cardiac complications, intraoperative blood loss, and postoperative indicators including hospital stay, duration of intensive care unit (ICU) stay and costs (P>0.05). Conclusion With thorough preoperative evaluation, intraoperative management, and postoperative care, CRC surgery can be safely performed in patients with reduced LVEF. Individualized preoperative assessment and comprehensive perioperative management are crucial for favorable outcomes.
Objective To develop and validate a predictive model for severe low anterior resection syndrome (LARS) at 3 months after stoma reversal in patients with mid-low rectal cancer. Methods Patients with mid-low rectal cancer who underwent temporary stoma placement (n=388) were in the Department of Gastrointestinal and Colorectal Surgery of the First Hospital of Jilin University from April 2021 to October 2022 prospectively enrolled. Baseline patient data, tumor characteristics, and Glazer pelvic floor electromyography assessment results were collected. Predictors were identified using logistic regression, and a nomogram model was constructed. Model performance was validated using the Bootstrap method (1000 resamples). Results Among all the enrolled patients, 186 cases (47.9%) had minor or no LARS (preoperative LARS score<30) and 202 cases (52.1%) had severe LARS (preoperative LARS score ≥30). Independent predictors for severe LARS at 3 months after stoma reversal included BMI (OR=1.18, 95%CI 1.09-1.27, P<0.001), anastomotic leakage (OR=2.94, 95%CI 1.11-7.83, P=0.031), baseline defecatory dysfunction(OR=4.88, 95%CI 2.96-8.03, P<0.001), and Glazer endurance contraction value (OR=0.94, 95%CI 0.90-0.99, P=0.023). Based on the above influencing factors, a nomogram model for predicting the risk of severe LARS was constructed. The area under the receiver operating characteristic curve of the model was 0.75 (95% CI 0.70-0.80). The Hosmer-Lemeshow test results indicated the model fit well (χ2=9.723, P=0.285). Conclusion The predictive model developed in this study provides a practical tool for identifying high-risk patients for severe LARS at 3 months after temporary stoma reversal. It is recommended to implement prehabilitation and early pelvic floor functional interventions for high-risk populations (such as those with obesity or baseline defecatory dysfunction) to improve prognosis.
Laparoscopic common bile duct exploration is an important method for treating extrahepatic bile duct stones, but its operation has a certain level of difficulty, which limits its widespread application. The choledochoscope can be inserted through the cystic duct or a cut on the anterior wall of the common bile duct. During the procedure, it is necessary to maintain a clear view by adjusting the angle of the scope and the water injection pressure. After advancing to the distal end of the common bile duct, the scope should be slowly withdrawn for observation. Depending on the size and location of the stones, methods such as stone retrieval baskets, irrigation, electrohydraulic lithotripsy, or laser lithotripsy can be used. To avoid missing stones, the distal end of the bile duct should be carefully examined and confirmed with a stone retrieval basket, with reference to preoperative imaging results and, if necessary, intraoperative cholangiography. The common bile duct incision can be managed with T-tube drainage or primary closure. The timing of postoperative choledochoscopic exploration via the T-tube tract varies depending on the surgical approach and the patient’s condition.
In recent years, digestive endoscopy has become a first-line method for the clinical diagnosis and treatment of benign biliary strictures (BBS). Endoscopic retrograde cholangiopancreatography (ERCP), endoscopic ultrasonography (EUS), and emerging cholangioscopy technologies can not only provide clear real-time images of biliary lesions but also obtain pathological samples, helping to establish a qualitative diagnosis of biliary strictures. Adequate endoscopic dilation combined with large-diameter stent placement has become a standard treatment approach for BBS. This method can achieve long-term efficacy similar to that of traditional surgical operation, while offering advantages such as minimal invasiveness and no alteration of the natural anatomical structure. However, differentiated therapeutic strategies need to be adopted based on the specific aetiology and disease course of individual patients.
Reasonable selection of imaging techniques is crucial for accurate diagnosis and treatment of benign biliary diseases. Transabdominal ultrasound (TUS) is the first choice in biliary diseases examination, while contrast enhanced ultrasound (CEUS) is mainly used in identification of biliary lesions. CT can clarify the presence of complications and exclude other acute abdominal diseases, becoming the preferred method for postoperative follow-up of biliary system diseases. Magnetic resonance cholangiopancreatography (MRCP) is currently the most ideal non-invasive technique for biliary tree imaging. Endoscopic techniques, such as endoscopic ultrasound (EUS) and endoscopic retrograde cholangiopancreatography (ERCP), play an important role in the diagnosis of benign biliary diseases. After TUS examination, next examination plans such as CEUS, plain/enhanced CT, MRI/MRCP, EUS, etc. should be performed according to the patient’s condition.
The treatment paradigm for intermediate to advanced hepatocellular carcinoma (HCC) is shifting from transarterial chemoembolization (TACE) monotherapy toward TACE-based combination strategies. Mechanistically, TACE remodels the tumor microenvironment (TME), thereby creating favorable conditions for systemic therapy. Targeted therapy normalizes tumor vasculature and enhances immune cell infiltration into the tumor by inhibiting angiogenesis and improving the TME. Immunotherapy further augments and sustains the antitumor immune response initiated by TACE and targeted agents through reversal of T-cell suppression, resulting in synergistic and durable systemic antitumor effects. Phase Ⅲ clinical trials have preliminarily demonstrated that TACE combined with targeted and immunotherapeutic agents significantly prolongs progression-free survival with a manageable safety profile. However, long-term survival benefits and tolerability in patients with impaired liver function require further validation. Future efforts should focus on optimizing treatment sequencing, frequency, and patient selection strategies, as well as exploring biomarker-guided individualized therapy to further improve clinical outcomes in intermediate-advanced HCC.
Post acute pancreatitis diabetes mellitus is a common long term complication of acute pancreatitis (AP), with a 5 year cumulative incidence of approximately 40%. Diagnosis requires exclusion of pre existing diabetes and confirmation ≥ 90 days after an AP episode according to the American Diabetes Association criteria. High risk groups include younger patients, those with recurrent, severe, or necrotising AP, and individuals with pancreatic exocrine insufficiency, intrapancreatic fat deposition or metabolic syndrome. The pathogenesis is multifactorial, encompassing β cell injury, autoimmune activation, inflammation driven insulin resistance and disruption of the gut-islet axis. Management priorities include aggressive fluid resuscitation and anti inflammatory therapy during the acute phase to limit residual damage; periodic glycaemic screening during convalescence; and metformin as the first line glucose lowering agent, with early insulin and pancreatic enzyme replacement when needed to optimise glycaemic control and nutrition.For patients undergoing total pancreatectomy, autologous islet transplantation may be considered to optimize long-term outcomes.
