Hepatobiliary Pancreat Dis Int

	2019 Vol. 18 No. 1
	Published: 2019-02-15


	Pages 1-100
	EDITORIAL META-ANALYSIS REVIEW ARTICLES ORIGINAL ARTICLES/Liver ORIGINAL ARTICLES/Biliary ORIGINAL ARTICLES/Pancreas LETTERS TO THE EDITOR

EDITORIAL

	1	Pan Q, Fan JG
		Noninvasive diagnosis of nonalcoholic steatohepatitis: Emerging approaches ^Hot!
		Nonalcoholic steatohepatitis (NASH), a severe type of nonalcoholic fatty liver disease (NAFLD), progresses toward liver fibrosis/cirrhosis, liver failure, and furthermore, hepatocellular carcinoma (HCC) [1]. The pathological manifestations are hepatocyte steatosis (> 5%), lobular inflammation, and ballooning degeneration, with or without fibrogenesis [2]. NAFLD/NASH results from sedentary life style, western diet, and obesity. We have witnessed the conversion of spectrum of chronic liver diseases from viral hepatitis as the leading cause to NAFLD/NASH worldwide [3]. Diagnosis of NASH is therefore of great importance for the clinical management, evaluation, and follow-up.
		Hepatobiliary Pancreat Dis Int. 2019; 18(1): 1-3 . [Abstract] ( 117 ) [HTML 1KB] [PDF 0KB] ( 123 )

META-ANALYSIS

	4	Bekheit M, Catanzano M, Shand S, Ahmed I, ELKayal E, Mohamed Shehata G, Zaki A
		The role of graft reperfusion sequence in the development of non-anastomotic biliary strictures following orthotopic liver transplantation: A meta-analysis
		Background: Liver transplant is a potential cure for liver failure and hepatic malignancy but there are many techniques which have been described for vascular reconstruction. This study was to compare the prevalence of non-anastomotic biliary stricture and other surgical complications based on Clavien-Dindo scoring system, in initial portal reperfusion (sequential) versus simultaneous or initial artery reperfusion. Data sources: Meta-analysis of published studies comparing the outcomes of both techniques was carried out. Data search was conducted across the major databases and studies were selected under the guidance of the Cochrane guidelines for systematic reviews and meta-analysis. Results: Seven studies were included to address the primary and the secondary outcomes. No statistical difference was found in the incidence of non-anastomotic biliary strictures (OR = 0.40; P = 0.14), regardless of reperfusion technique. The pooled estimate of the Clavien-Dindo grading of complications was not significantly different between the techniques, though Clavien-Dindo II complications were higher in the simultaneous or initial artery reperfusion group than the initial portal reperfusion group (OR = 2.73; P = 0.01). Similarly, there was no difference in the operative time, hospital stay and other outcomes ad- dressed in this report. Conclusions: The available evidence suggests that there is no significant difference demonstrated in the rate of non-anastomotic biliary strictures or other complications, between the two techniques, except for Clavien-Dindo II complications.
		Hepatobiliary Pancreat Dis Int. 2019; 18(1): 4-11 . [Abstract] ( 125 ) [HTML 1KB] [PDF 0KB] ( 138 )

	12	Li DB, Si XY,Wang SJ, Zhou YM
		Long-term outcomes of combined hepatocellular-cholangiocarcinoma after hepatectomy or liver transplantation: A systematic review and meta-analysis ^Hot!
		Background: Combined hepatocellular-cholangiocarcinoma (cHCC-CC) is a rare primary liver malignancy. We conducted a systematic review and meta-analysis to assess the evidence available on the long-term outcomes of cHCC-CC patients after either hepatectomy or liver transplantation (LT). Data Sources: Relevant studies published between January 2000 and January 2018 were identified by searching PubMed and Embase and reviewed systematically. Data were pooled using a random-effects model. Results: A total of 42 observational studies involving 1691 patients (1390 for partial hepatectomy and 301 for LT) were included in the analysis. The median tumor recurrence and 5-year overall survival (OS) rates were 65% (range 38%–100%) and 29% (range 0–63%) after hepatectomy versus 54% (range 14%–93%) and 41% (range 16%–73%) after LT, respectively. Meta-analysis found no significant difference in OS and tumor recurrence between LT and hepatectomy groups. Conclusion: Hepatectomy rather than LT should be considered as the prior treatment option for cHCC-CC.
		Hepatobiliary Pancreat Dis Int. 2019; 18(1): 12-18 . [Abstract] ( 133 ) [HTML 1KB] [PDF 0KB] ( 130 )

REVIEW ARTICLES

	19	Jiang JW, Chen XH, Ren Z, Zheng SS
		Gut microbial dysbiosis associates hepatocellular carcinoma via the gut-liver axis ^Hot!
		Background: Hepatocellular carcinoma (HCC) is one of the most common malignancies in the world. Gut microbiota has been demonstrated to play a critical role in liver inflammation, chronic fibrosis, liver cirrhosis, and HCC development through the gut-liver axis. Data sources: Recently there have been several innovative studies investigating gut microbial dysbiosis-mediated enhancement of HCC through the gut-liver axis. Literatures from January 1998 to January 2018 were searched in the PubMed database using the keywords “gut microbiota” and “hepatocellular carcinoma” or “liver cancer”, and the results of experimental and clinical studies were analyzed. Results: Gut microbial dysbiosis accompanies the progression of alcoholic liver disease, non-alcoholic fatty liver disease and liver cirrhosis, and promotes HCC progression in an experimental mouse model. The immune system and key factors such as Toll-like receptor 4 are involved in the process. There is evidence for gut microbial dysbiosis in hepatitis virus-related HCC patients. Conclusions: Gut microbial dysbiosis is closely associated with hepatic inflammation disease and HCC through the gut-liver axis. With the enhanced understanding of the interactions between gut microbiota and liver through the gut-liver axis, new treatment strategies for HCC are being developed.
		Hepatobiliary Pancreat Dis Int. 2019; 18(1): 19-27 . [Abstract] ( 120 ) [HTML 1KB] [PDF 0KB] ( 135 )

ORIGINAL ARTICLES/Liver

	28	Kroh A, Uschner D, Lodewick T, Eickhoff RM, SchoningW, Ulmer FT, Neumann UP, Binnebosel M
		Impact of body composition on survival and morbidity after liver resection in hepatocellular carcinoma patients
		Background: Hepatocellular carcinoma is the most common innate liver tumor. Due to improved surgical techniques, even extended resections are feasible, and more patients can be treated with curative intent. As the liver is the central metabolic organ, preoperative metabolic assessment is crucial for risk strati- fication. Sarcopenia, obesity and sarcopenic obesity characterize body composition and metabolic status. Here we present the impact of body composition on survival after liver resection in patients with hepa- tocellular carcinoma. Methods: A retrospective database analysis of 70 patients who were assigned for liver resection due to hepatocellular carcinoma was conducted. For assessment of sarcopenia and obesity, skeletal muscle surface area was measured at lumbar vertebra 3 level (L3) in preoperative four-phase contrast enhanced abdominal CT scans, and L3 muscle index and body fat percentage were calculated. Results: Univariate analysis comparing the survival curves using the score test demonstrated superior postoperative overall survival for sarcopenic ( P = 0.035) and sarcopenic obese ( P = 0.048) patients as well as a trend favoring obese ( P = 0.130) subjects. Whereas multivariate analysis could not identify significant difference in postoperative survival regarding sarcopenia, obesity or sarcopenic obesity. Only large tumor size, multifocal disease and male gender were risk factors for long-term survival. Conclusions: Sarcopenia, obesity and sarcopenic obesity are indeed no risk factors for poor postoperative survival in this study. Our data do not support the evaluation of sarcopenia, obesity and sarcopenic obesity before liver resection in hepatocellular carcinoma patients.
		Hepatobiliary Pancreat Dis Int. 2019; 18(1): 28-37 . [Abstract] ( 120 ) [HTML 1KB] [PDF 0KB] ( 139 )

	38	Ren JJ, Huang TJ, Zhang QQ, Zhang HY, Guo XH, Fan HQ, Li RK, Liu LX
		Insulin- like growth factor binding protein related protein 1 knockdown attenuates hepatic fibrosis via the regulation of MMPs/TIMPs in mice ^Hot!
		Background: Previous research suggested that insulin-like growth factor binding protein related protein 1 (IGFBPrP1), as a novel mediator, contributes to hepatic fibrogenesis. Matrix metalloproteinases (MMP) and tissue inhibitors of metalloproteinases (TIMP) play an essential role in hepatic fibrogenesis by regu- lating homeostasis and remodeling of the extracellular matrix (ECM). However, the interaction between IGFBPrP1 and MMP/TIMP is not clear. The present study was to knockdown IGFBPrP1 to investigate the correlation between IGFBPrP1 and MMP/TIMP in hepatic fibrosis. Methods: Hepatic fibrosis was induced by thioacetamide (TAA) in mice. Knockdown of IGFBPrP1 expres- sion by ultrasound-targeted microbubble destruction-mediated CMB-shRNA-IGFBPrP1 delivery, or inhi- bition of the Hedgehog (Hh) pathway by cyclopamine treatment, was performed in TAA-induced liver fibrosis mice. Hepatic fibrosis was determined by hematoxylin and eosin and Sirius red staining. Hepatic expression of IGFBPrP1, α-smooth muscle actin ( α-SMA), transforming growth factor β1 (TGF β1), collagen I, MMPs/TIMPs, Sonic Hedgehog (Shh), and glioblastoma family transcription factors (Gli1) were investigated by immunohistochemical staining and Western blotting analysis. Results: We found that hepatic expression of IGFBPrP1, TGF β1, α-SMA, and collagen I were increased longitudinally in mice with TAA-induced hepatic fibrosis, concomitant with MMP2/TIMP2 and MMP9/TIMP1 imbalance and Hh pathway activation. Knockdown of IGFBPrP1 expression, or inhibition of the Hh pathway, reduced the hepatic expression of IGFBPrP1, TGF β1, α-SMA, and collagen I and re-established MMP2/TIMP2 and MMP9/TIMP1 balance. Conclusions: Our findings suggest that IGFBPrP1 knockdown attenuates liver fibrosis by re-establishing MMP2/TIMP2 and MMP9/TIMP1 balance, concomitant with the inhibition of hepatic stellate cell activation, down-regulation of TGF β1 expression, and degradation of the ECM. Furthermore, the Hh pathway mediates IGFBPrP1 knockdown-induced attenuation of hepatic fibrosis through the regulation of MMPs/TIMPs balance.
		Hepatobiliary Pancreat Dis Int. 2019; 18(1): 38-47 . [Abstract] ( 116 ) [HTML 1KB] [PDF 0KB] ( 147 )

	48	Ge YS, Zhang QZ, Li H, Bai G, Jiao ZH,Wang HB
		Hydrogen-rich saline protects against hepatic injury induced by ischemia-reperfusion and laparoscopic hepatectomy in swine
		Background: Hydrogen-rich saline (HRS) has antioxidative, anti-inflammatory and anti-apoptotic properties. We investigated the effects of hydrogen on hepatic ischemia-reperfusion (I/R) and laparoscopic hepatectomy in swine. Methods: Twenty-one healthy Bama miniature pigs were randomly divided into the sham group, ischemia-reperfusion injury (IRI) group, HRS-5 (5 mL/kg) group, and HRS-10 (10 mL/kg) group. HRS was injected through the portal vein 10 min before reperfusion and at postoperative day 1, 2 and 3. The roles of HRS on oxidative stress, inflammatory response and liver regeneration were studied. Results: Compared with the IRI group, HRS treatment attenuated oxidative stress by increasing catalase activity and reducing myeloperoxidase. White blood cells in the HRS-10 group were reduced compared with the IRI group ( P < 0.01). In the HRS-10 group, interleukin-1 beta, interleukin-6 and tumor necrosis factor alpha, C-reactive protein and cortisol were downregulated, whereas interleukin-10 was upregulated. In addition, HRS attenuated endothelial cell injury and promoted the secretion of angiogenic cy- tokines, including vascular endothelial growth factor, angiopoietin-1 and angiopoietin-2. HRS elevated the levels of hepatocyte growth factor, Cyclin D1, proliferating cell nuclear antigen, Ki-67 and reduced the secretion of transforming growth factor-beta. Conclusions: HRS treatment may exert a protective effect against I/R and hepatectomy-induced hepatic damage by reducing oxidative stress, suppressing the inflammatory response and promoting liver regen- eration.
		Hepatobiliary Pancreat Dis Int. 2019; 18(1): 48-61 . [Abstract] ( 120 ) [HTML 1KB] [PDF 0KB] ( 125 )

ORIGINAL ARTICLES/Biliary

	62	Jo JH, Kang H, Lee HS, Chung MJ, Park JY, Bang S, Park SW, Song SY
		KML001, an arsenic compound, as salvage chemotherapy in refractory biliary tract cancers: A prospective study
		Background: Sodium meta-arsenite (NaAsO 2 , KML001) is a potential oral anticancer agent acting on telomerase and telomere length. This prospective study evaluated its safety, tolerability, and effectiveness as salvage chemotherapy in patients with advanced biliary tract cancer (BTC) resistant to gemcitabine- based chemotherapy. Methods: Forty-four patients (21 women and 23 men) with advanced BTC and failure history of gemcitabine-based chemotherapy, performance status (PS) 0–2, normal cardiac, hepatic, and renal func- tion were enrolled. Daily dose of KML001 (7.5 mg. p.o.) was administered to eligible subjects for 24 weeks divided into six treatment cycles. Response was evaluated bimonthly using CT. Results: After an average of 1.5 months of treatment (range: 0.5–10.0), 3 patients (6.8%) obtained progression-free status, 23 patients (52.3%) had disease progression, and 18 patients (40.9%) dropped out before evaluation. One patient (2.3%) completed six treatment cycles without progression. During the treatment, morphine dosage kept the same or decreased in 20 patients (47.6%). Nine patients (20.5%) experienced grade-3 adverse events (AEs), while no patient experienced grade-4 AEs. The most common AEs were liver enzyme elevation (11/44, 25%) and anemia (10/44, 22.7%). KML001 was discontinued in six patients (13.6%) due to AEs, including liver toxicity ( n = 3), QTc prolongation ( n = 2), and abdominal pain ( n = 1). Conclusions: KML001 did not have enough anticancer effect on patients with advanced BTC resistant to gemcitabine. However, KML001 was safe and well-tolerable in terms of AEs and pain control when used as salvage therapy. Further studies are needed to establish arsenic agents as a reliable treatment option in patients with BTC.
		Hepatobiliary Pancreat Dis Int. 2019; 18(1): 62-66 . [Abstract] ( 114 ) [HTML 1KB] [PDF 0KB] ( 141 )

ORIGINAL ARTICLES/Pancreas

	67	El Nakeeb A, El Sorogy M, Hamed H, Said R, Elrefai M, Ezzat H, AskarW, Elsabagh AM
		Biliary leakage following pancreaticoduodenectomy: Prevalence, risk factors and management ^Hot!
		Background: Few studies investigated biliary leakage after pancreaticoduodenectomy (PD) especially when compared to postoperative pancreatic fistula (POPF). This study was to determine the incidence of biliary leakage after PD, predisposing factors of biliary leakage, and its management. Methods: We retrospectively studied all patients who underwent PD from January 2008 to December 2017 at Gastrointestinal Surgery Center, Mansoura University, Egypt. According to occurrence of postoper- ative biliary leakage, patients were divided into two groups. Group (1) included patients who developed biliary leakage and group (2) included patients without identified biliary leakage. The preoperative data, operative details, and postoperative morbidity and mortality were analyzed. Results: The study included 555 patients. Forty-four patients (7.9%) developed biliary leakage. Ten patients (1.8%) had concomitant POPF. Multivariate analysis identified obesity and time needed for hepaticojejunostomy reconstruction as independent risk factors of biliary leakage, and no history of preoperative endoscopic retrograde cholangiopancreatiography (ERCP) as protective factor. Biliary leakage from hepaticojejunostomy after PD leads to a significant increase in development of delayed gastric emptying, and wound infection. The median hospital stay and time to resume oral intake were significantly greater in the biliary leakage group. Non-surgical management was needed in 40 patients (90.9%). Only 4 patients (9.1%) required re-exploration due to biliary peritonitis and associated POPF. The mortality rate in the biliary leakage group was significantly higher than that of the non-biliary leakage group (6.8% vs 3.9%, P = 0.05). Conclusions: Obesity and time needed for hepaticojejunostomy reconstruction are independent risk factors of biliary leakage, and no history of preoperative ERCP is protective factor. Biliary leakage increases the risk of morbidity and mortality especially if concomitant with POPF. However, biliary leakage can be conservatively managed in majority of cases.
		Hepatobiliary Pancreat Dis Int. 2019; 18(1): 67-72 . [Abstract] ( 118 ) [HTML 1KB] [PDF 0KB] ( 133 )

	73	Wen J, Li T, Lu Y, Bie LK, Gong B
		Comparison of efficacy and safety of transpancreatic septotomy, needle-knife fistulotomy or both based on biliary cannulation unintentional pancreatic access and papillary morphology
		Background: Precut sphincterotomy has been widely performed to facilitate selective biliary access when standard cannulation attempts failed during endoscopic retrograde cholangiopancreatography (ERCP). However, scarce data are available on different precut techniques for difficult biliary cannulation. This study aimed to evaluate the efficacy and safety of transpancreatic septotomy (TPS), needle-knife fistulotomy (NKF) or both based on the presence of unintentional pancreatic access and papillary morphology. Methods: Between March 2008 and December 2016, 157 consecutive patients undergoing precutting for an inaccessible bile duct during ERCP were identified. Precut techniques were chosen depending on repetitive inadvertent pancreatic cannulation and the papillary morphology. We retrospectively assessed the rates of cannulation success and procedure-related complications among three groups, namely TPS, NKF, and TPS followed by NKF. Results: The baseline characteristics of the three groups were comparable. The overall success rate of biliary cannulation reached 98.1%, including 111 of 113 (98.2%) with TPS, 35 of 36 (97.2%) with NKF and 8 of 8 (100%) with NKF following TPS, without significant difference among groups. The incidences of total complications and post-ERCP pancreatitis were 9.6% and 7.6%, respectively. There was a trend towards less frequent post-ERCP pancreatitis after NKF (0%) compared with 11 cases (9.7%) after TPS and one case (12.5%) after NKF following TPS, but not significantly different ( P = 0.07). No severe adverse event occurred during this study period. Conclusions: The choice of precut techniques by the presence of unintended pancreatic access and the papillary morphology brought about a high success rate without increasing risk in difficult biliary cannu- lation.
		Hepatobiliary Pancreat Dis Int. 2019; 18(1): 73-78 . [Abstract] ( 110 ) [HTML 1KB] [PDF 0KB] ( 131 )

	79	Perrotta de Souza LM, Moreira JPL, Foga?a HS, Eulálio JMR, Luiz RR, de Souza HSP
		Increasing pancreatic cancer is not paralleled by pancreaticoduodenectomy volumes in Brazil: A time trend analysis
		Background: Currently, surgical resection represents the only curative treatment for pancreatic cancer (PC), however, the majority of tumors are no longer resectable by the time of diagnosis. The aim of this study was to describe time trends and distribution of pancreaticoduodenectomies (PDs) performed for treating PC in Brazil in recent years. Methods: Data were retrospectively obtained from Brazilian Health Public System (namely DATASUS) regarding hospitalizations for PC and PD in Brazil from January 2008 to December 2015. PC and PD rates and their mortalities were estimated from DATASUS hospitalizations and analyzed for age, gender and demographic characteristics. Results: A total of 2364 PDs were retrieved. Albeit PC incidence more than doubled, the number of PDs increased only 37%. Most PDs were performed in men (52.2%) and patients between 50 and 69 years old (59.5%). Patients not surgically treated and those 70 years or older had the highest in-hospital mortality rates. The most developed regions (Southeast and South) as well as large metropolitan integrated municipalities registered 76.2% and 54.8% of the procedures, respectively. LMIM PD mortality fluctuated, ranging from 13.6% in 2008 to 11.8% in 2015. Conclusions: This study suggests a trend towards regionalization and volume-outcome relationships for PD due to PC, as large metropolitan integrated municipalities registered most of the PDs and more stable mortality rates. The substantial differences between PD and PC increasing rates reveals a limiting step on the health system resoluteness. Reduction in the number of hospital beds and late access to hospitaliza- tion, despite improvement in diagnostic methods, could at least in part explain these findings.
		Hepatobiliary Pancreat Dis Int. 2019; 18(1): 79-86 . [Abstract] ( 121 ) [HTML 1KB] [PDF 0KB] ( 125 )

LETTERS TO THE EDITOR

	87	Chu KKW, Chok KSH, Fung JYY, Chan ACY, DaiWC, Lo CM
		Emergency ABO-incompatible living donor liver transplant for patients with ultrahigh MELD scores
		A 49-year-old Chinese man with treatment-naïve chronic hepatitis B presented with a one-week history of jaundice when admitted to our hospital. On admission, his bilirubin was 704 μmol/L, alanine aminotransferase 180 U/L, international normalized ratio 2.4, creatinine 140 μmol/L, and Model for End-stage Liver Disease (MELD) score 35. His serum HBV DNA was 64.7 IU/mL, and he was commenced on entecavir. Nonetheless, he developed acute-onchronic liver failure on day 28 with grade 2 hepatic encephalopathy and a MELD score of 40 (bilirubin 709 μmol/L, international normalized ratio 3.3, creatinine 181 μmol/L). During his admission, he developed bacteremia and spontaneous bacterial peritonitis (SBP). His blood culture was positive of enterococcus faecium and coagulase-negative staphylococcus and his peritoneal fluid culture was positive of coagulase-negative staphylococcus . This was further complicated by the development of type 1 hepatorenal syndrome. His initial condition was so poor that intensive care with inotrope was needed. At the time of preconditioning, the sepsis due to SBP was barely controlled after optimization.
		Hepatobiliary Pancreat Dis Int. 2019; 18(1): 87-89 . [Abstract] ( 114 ) [HTML 1KB] [PDF 0KB] ( 142 )

	90	Xue C, Ren Z, Hu X, He Y, Sun R, Li J, Cui G, Yu Z
		The successful treatment for cardiac tamponade during radiofrequency ablation of hepatocellular carcinoma
		Hepatocellular carcinoma (HCC) is the second most common cause of cancer-related death worldwide [1] . Repeated liver resection remains a valid and safe curative therapy option for recurrent HCC in a minority of patients, because of multifocal intrahepatic or extra-hepatic recurrence and tumors in unresectable locations [2] . HCC nodules less than 3 cm located in the hepatic dome beneath the diaphragm may represent one of the most difficult sites for resection [3] . Therefore, some local invasive therapies, such as radiofrequency ablation (RFA), microwave ablation, transarterial chemoembolization (TACE) and laser hyperthermia, have been developed and applied in clinical HCC treatment [4] . RFA has high frequency energy which heats the surrounding tissues and causes severe complications such as acute massive hemorrhage, thermal injury to viscera, pneumothorax and cardiac tamponade [5] .
		Hepatobiliary Pancreat Dis Int. 2019; 18(1): 90-92 . [Abstract] ( 115 ) [HTML 1KB] [PDF 0KB] ( 146 )

	93	Darnis B, Mohkam K, Cauchy F, Mabrut JY
		Double cholecystectomy in case of accessory gallbladder: Not as easy as two cholecystectomies
		Accessory gallbladders (AG) are rare and their management are usually challenging. These variations are related with an abnormal division of the bile ducts precursors between the 5th and the 12th week of pregnancy. Harlaftis et al. [1] proposed an anatomical classification of these variations based on the embryologic abnormalities described. In type 1 both gallbladders are connected to the common bile duct at the same location. In type 2 the AG can reach either the common bile duct (ductular type) or an intrahepatic biliary duct (trabecular type). In type 3, three gallbladders are present. A fourth type was recently added to the Harlaftis classification [2]. In this type, the AG is not connected to the biliary tree or the gut. The histologic structure of an AG is the same as a normal gallbladder with the presence of a muscular layer in the gallbladder wall, whereas this layer is not present in the upper part of the main bile duct. The two main lesions that mimic an AG are a hepatic cyst near the gallbladder and a Todani II bile duct cyst (or bile duct diverticulum). In this last case a muscular layer is not found, which is the only characteristic that differentiate it from an AG [2]. The prevalence of AG seems to be higher in eastern countries [2–5]. The oncological risk of such biliary malformation seems to be low [2, 4]. We herein presented our experience of the AG management in 4 cases.
		Hepatobiliary Pancreat Dis Int. 2019; 18(1): 93-95 . [Abstract] ( 109 ) [HTML 1KB] [PDF 0KB] ( 123 )

	96	Kitamura K, Yamamiya A, Ishii Y, Mitsui Y, Yoshida H
		Clinical outcomes of endoscopic ultrasonography-guided transmural drainage using plastic stent and nasocystic drain for pancreatic and peripancreatic collections
		Pancreatic and peripancreatic collections (PCs) develop from acute pancreatitis (AP), chronic pancreatitis, surgery, or trauma. The 2012 revised Atlanta classification [1] of AP classified local complications into the following 4 PC types: acute peripancreatic fluid collection ( < 4 weeks after the onset of acute interstitial edematous pancreatitis), acute necrotic collection ( < 4 weeks after the onset of acute necrotizing pancreatitis), pancreatic pseudocyst (PPC; ≥4 weeks after the onset of acute interstitial edematous pancreatitis), and walled-off necrosis (WON; ≥4 weeks after the onset of acute necrotizing pancreatitis). Endoscopic ultrasonographyguided transmural drainage (EUS-TD) has been reported to be a minimally invasive procedure for patients with PCs [2–4] . This study aimed to investigate the clinical outcomes of EUS-TD for PCs.
		Hepatobiliary Pancreat Dis Int. 2019; 18(1): 96-99 . [Abstract] ( 99 ) [HTML 1KB] [PDF 0KB] ( 127 )

	100	Quan B, Yan WT, Lau WY, Wu MC, Yang T
		Impact of delayed time from diagnosis to treatment on the stage of hepatocellular carcinoma
		We read with interest of the article by Dr. Lim et al. [1] . The authors concluded that a delay of ≥3 months from diagnosis to treatment in patients with Barcelona clinic liver cancer ( BCLC) 0- A st age hepatocellular carcinoma (HCC) does not affect long-term outcomes after curative resection compared with those with a delay of < 3 months. Undoubtedly, this is a challenging viewpoint, which is contrary to traditional concept – the sooner the tumor removal, the better the oncologic prognosis. Herein, we would like to raise the following comments:
		Hepatobiliary Pancreat Dis Int. 2019; 18(1): 100-100 . [Abstract] ( 117 ) [HTML 1KB] [PDF 0KB] ( 124 )

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