Hepatobiliary Pancreat Dis Int

	2021 Vol. 20 No. 2
	Published: 2021-04-15


	Pages 103-204
	EDITORIAL REVIEW ARTICLES ORIGINAL ARTICLES/Liver ORIGINAL ARTICLES/Biliary ORIGINAL ARTICLES/Pancreas LETTERS TO THE EDITOR

EDITORIAL

	103	Tian XD, Yang YM
		A new nomogram for predicting lymph node positivity in pancreatic cancer
		Pancreatic cancer (PC) is one of the most dismal malignancies, and radical resection in combination with perioperative systemic chemotherapy provides the only chance of long-term survival [1]. However, surgeons have been increasingly aware that some anatomically resectable PC patients cannot benefit from upfront surgery. The majority of PC patients with radical resection will suffer from local recurrence or systematic metastasis in 1-2 years after surgery, especially for those with pathological positive lymph nodes (LNs) [2]. Hence, the preoperative identification of PC patients with LN metastasis is essential for either prognosis prediction or administration of neoadjuvant chemotherapy or radiochemotherapy. However, it is reported that approximately 70% of PC patients who were clinically diagnosed as node negative finally proved to have nodal involvement upon pathological evaluation, indicating that the radiological staging of nodule involvement before surgery is still difficult [3]. Therefore, the development of prediction models for preoperative determination of pathological LN positivity in resectable PC patients has potential significance for optimizing the individualized comprehensive treatment strategies before surgery.
		Hepatobiliary Pancreat Dis Int. 2021; 20(2): 103-104 . [Abstract] ( 109 ) [HTML 1KB] [PDF 0KB] ( 169 )

	105	Zhang JG, Yang HY, Mao YL
		Novel 3D preclinical model systems with primary human liver cells: Recent progresses, applications and future prospects
		Liver plays a central role in various physiological functions, including metabolism, biliary secretion, production of plasma proteins, regulation of hormones as well as detoxication. Because of its multidimensional functions, liver diseases such as viral hepatitis, non-alcoholic fatty liver disease, non-alcoholic steatohepatitis, fibrosis and liver cancer may lead to serious consequences. However, the therapeutic options for these diseases are limited [1]. Preclinical models are important to explore the managements of patients with liver diseases. However, the traditional cell line and xenografted mice are not satisfying in preclinical studies [2]. We need to create patient-derived preclinical models with high robustness of cell fate maintenance, high-level tissue self-assembly accuracy and ability to exhibit dynamics of physiological processes. This article reviewed recent progresses, applications and future prospects of novel preclinical model systems with primary human liver cells, including spheroid systems, patient-derived organoid (PDO), microfluidic systems, bioprinting and patient-derived xenograft (PDX).
		Hepatobiliary Pancreat Dis Int. 2021; 20(2): 105-107 . [Abstract] ( 112 ) [HTML 1KB] [PDF 0KB] ( 173 )

	108	Hu Y, Shen ZH
		Practice of precision surgery in primary liver cancer
		Primary liver cancer (PLC) is mainly composed of three major cancer: intrahepatic cholangiocarcinoma, hepatocellular carcinoma and mixed hepatocellular-cholangiocellular carcinoma. PLC is the sixth most common cancer and the second most common cause of cancer-related death worldwide [1]. Although scientists tried hard to explore the mechanisms and treatments, patients with PLC have poor prognoses and the treatments remain challenging [2], and surgical resection or liver transplantation is the only treatment for long-term survival.
		Hepatobiliary Pancreat Dis Int. 2021; 20(2): 108-109 . [Abstract] ( 115 ) [HTML 1KB] [PDF 0KB] ( 181 )

REVIEW ARTICLES

	110	Baltatzis M, Jegatheeswaran S, Siriwardena AK
		Reporting of longitudinal pancreatojejunostomy with partial pancreatic head resection (the Frey procedure) for chronic pancreatitis: A systematic review ^Hot!
		Background: Longitudinal pancreatojejunostomy with partial pancreatic head resection (the Frey procedure) is accepted for surgical treatment of painful chronic pancreatitis. However, conduct and reporting are not standardized and thus, making comparisons difficult. This study assesses the reporting standards of this procedure. Data sources: A systematic literature review was performed between January 1987 and January 2020. The keyword and Medical Subject Heading “chronic pancreatitis” was used together with the individual operation term “Frey pancreatojejunostomy”. Reports were included if they provided original information on conduct and outcome. Thirty-three papers providing information on 1205 patients constituted the study population. Risk of bias in included reports was assessed. Results: Etiology of chronic pancreatitis (alcohol) was reported in 26 of 28 (93%) studies, duration of symptoms prior to surgery in 19 (58%) studies and preoperative opiate use in 12 (36%) studies. In terms of morphology, pancreatic duct diameter was reported in 17 (52%) studies and diameter of the pancreatic head in 13 (39%) studies. In terms of technique, three (9%) studies reported weight of excised parenchyma. There were 9 (0.7%) procedure-related deaths. Post-operative follow-up ranged from 6 to 82.5 months. No studies reported post-operative portal hypertension. Conclusions: There is substantial heterogeneity between studies in reporting of clinical baseline, morphology of the diseased pancreas, operative detail and outcome after longitudinal pancreatojejunostomy with partial pancreatic head resection. This critically compromises the comparison between centers and between surgeons. Structured reporting is necessary for clinicians to assess choice of procedure and for patients to make informed choices when seeking treatment for painful chronic pancreatitis.
		Hepatobiliary Pancreat Dis Int. 2021; 20(2): 110-116 . [Abstract] ( 108 ) [HTML 1KB] [PDF 0KB] ( 150 )

	117	Frountzas M, Schizas D, Liatsou E, Economopoulos KP, Nikolaou C, Apostolou KG, Toutouzas KG, Felekouras E
		Presentation and surgical management of xanthogranulomatous cholecystitis ^Hot!
		Background: Xanthogranulomatous cholecystitis (XGC) is a rare benign chronic inflammatory disease of the gallbladder that often presents as cholecystitis and most of the times requires surgical management. In addition, distinguishing XGC from gallbladder cancer preoperatively is still a challenge. The aim of the present systematic review was to outline the clinical presentation and surgical approach of XGC. Data sources: The present systematic review was designed using the PRISMA and AMSTAR guidelines. We searched MEDLINE, Scopus, Clinicaltrials.gov, EMBASE, Cochrane Central Register of Controlled Trials (CENTRAL) and Google Scholar databases from inception until June 2020. Results: The laparoscopic cholecystectomy rate (34%) was almost equal to the open cholecystectomy rate (47%) for XGC. An important conversion rate (35%) was observed as well. The XGC cases treated by surgery were associated with low mortality (0.3%), limited intraoperative blood loss (58-270 mL), low complication rates (2%-6%), along with extended operative time (82.6-120 minutes for laparoscopic and 59.6-240 minutes for open cholecystectomy) and hospital stay (3-9 days after laparoscopic and 8.3-18 days after open cholecystectomy). Intraoperative findings during cholecystectomies for XGC included empyema or Mirizzi syndrome. In addition, complex surgical procedures, like wedge hepatic resections and bile duct excision were required during operations for XGC. Conclusions: XGC seemed to be a rare, benign inflammatory disease that presents similar features as gallbladder cancer. The mortality and complication rates of XGC were low, despite the complex surgical procedures that might be required in some cases.
		Hepatobiliary Pancreat Dis Int. 2021; 20(2): 117-127 . [Abstract] ( 107 ) [HTML 1KB] [PDF 0KB] ( 159 )

ORIGINAL ARTICLES/Liver

	128	Sun XY, Wang GC, Wang J, Huang GJ, Zhang CQ
		Transjugular intrahepatic portosystemic shunt is effective in patients with chronic portal vein thrombosis and variceal bleeding
		Background: Studies about treatment of patients with chronic portal vein thrombosis (CPVT) are still limited, especially in different types of CPVT. This study aimed to evaluate the effect of transjugular intrahepatic portosystemic shunt (TIPS) in all types of CPVT with variceal bleeding. Methods: Patients with CPVT who received TIPS treatment between January 2011 and June 2019 were divided into four types according to the extent of thrombosis. All patients had a history of variceal bleeding. The characteristics and clinical parameters were collected and recorded. Data on procedure success rate, variation in portal vein pressure, rebleeding, hepatic encephalopathy (HE), stent stenosis, and overall mortality were analyzed. Results: A total of 189 patients were included in this study (39 in type 1, 84 in type 2, 48 in type 3, 18 in type 4). The TIPS procedure success rate was 86.2%. The success rate was significantly different among the four types (89.7% vs. 88.1% vs. 83.3% vs. 77.8%, P = 0.001). In the TIPS success group, portal vein pressure was significantly reduced from 27.15 ± 6.59 to 19.74 ± 6.73 mmHg after the procedure (P < 0.001) and the rebleeding rate was significantly lower than that of the fail group (14.7% vs. 30.8%, P = 0.017). In addition, there were no significant differences in HE rate (30.7% vs. 26.9%, P = 0.912) or overall mortality (12.9% vs. 19.2%, P = 0.403) between the TIPS success group and the fail group. In the TIPS success group, we found that the occurrence of HE was significantly different (P = 0.020) among the four types, while there were no significant differences in rebleeding rate (P = 0.669), stent stenosis rate (P = 0.056), or overall mortality (P = 0.690). Conclusions: TIPS was safe and effective in decreasing portal vein pressure and rebleeding rate in patients with CPVT.
		Hepatobiliary Pancreat Dis Int. 2021; 20(2): 128-136 . [Abstract] ( 98 ) [HTML 1KB] [PDF 0KB] ( 160 )

	137	Ma YJ, Du LY, Yan LB, Liao J, Cheng X, Xie WW, Tang H
		Long-term follow-up of HCV patients with sustained virological response after treatment with pegylated interferon plus ribavirin
		Background: The progress of liver diseases may not stop after viral eradication. This study aimed to provide data on long-term prognosis of patients with hepatitis C virus (HCV) infection who underwent pegylated interferon plus ribavirin (PR) regimen and achieved a sustained virological response 24 weeks post-treatment (SVR24). Methods: Responders to the PR regimen in our hospital from January 2011 to June 2014 were enrolled and prospectively followed up. Baseline characteristics were profiled. The incidence of hepatocellular carcinoma (HCC), progression of liver disease (increase in liver stiffness or occurrence of decompensated complication), and HCV recurrence was all monitored. The accumulative and annualized incidence rates (AIRs) of these adverse events were analyzed, and the risk factors were also examined. Results: In total, 151 patients reached a median follow-up time of 103 weeks. Among them, two had an incidence of HCC during the surveillance with AIR of 0.68% (95% CI: 0.00-1.63%). Six patients showed progression of liver disease with AIR of 2.05% (95% CI: 0.42%-3.68%). Three patients who had risky behaviors encountered HCV reinfection. The cirrhotic patients faced higher risk of poor prognosis than non-cirrhotic patients, including HCC and progression of liver disease (AIR: 6.17% vs. 1.42%, P = 0.039). Conclusions: The incidence of HCC and progression of liver disease was evident in PR responders during the long-term follow-up period, but the risk level was low. Cirrhotic responders were more vulnerable to develop HCC post SVR24 compared with non-cirrhotic ones. HCV recurrence was rare in responders with SVR24 who had corrected their risky behaviors.
		Hepatobiliary Pancreat Dis Int. 2021; 20(2): 137-141 . [Abstract] ( 106 ) [HTML 1KB] [PDF 0KB] ( 165 )

	142	Yan C, Li BH, Sun XT, Yu DC
		Laparoscopic hepatectomy is superior to open procedures for hepatic hemangioma
		Background: Laparoscopic hepatectomy (LH) has become increasingly popular for liver neoplasms, but its safety and effectiveness remain controversial. Hepatic hemangiomas are the most common benign liver neoplasm; the main approaches to hepatic hemangiomas include open hepatectomy (OH) and LH. In this study, we compared early outcomes between patients undergoing OH and those with LH. Methods: Patients underwent OH or LH in our hospital for hepatic hemangiomas between December 2013 and December 2017 were enrolled. All patients underwent comprehensive preoperative evaluations. The clinicopathological index and risk factors of hemangioma resection were assessed. Results: In total, 41 patients underwent OH while 53 underwent LH. There was no significant difference in any preoperative clinical variables, including liver function, prothrombin time, or platelet count. Hepatic portal occlusion time and operative time were 39.74 vs. 38.35 minutes ( P = 0.717) and 197.20 vs. 203.68 minutes ( P = 0.652) in the OH and LH groups, respectively. No mortality nor significant perioperative complications were observed between the two groups. In LH group, two cases were converted to OH, one for an oversized tumor and the other for hemorrhage. Compared with OH patients, those with LH had less blood loss (361.69 vs. 437.81 mL, P = 0.024), shorter postoperative hospital stay (7.98 vs. 11.07 days, P = 0.001), and lower postoperative C-reactive protein (43.63 vs. 58.21 mg/L, P = 0.026). Conclusions: LH is superior to OH in terms of postoperative recovery and blood loss for selected patients with hepatic hemangioma.
		Hepatobiliary Pancreat Dis Int. 2021; 20(2): 142-146 . [Abstract] ( 101 ) [HTML 1KB] [PDF 0KB] ( 180 )

	147	Liu YF, Sun XY, Zhang JK, Wang ZH, Ren ZG, Li J, Guo WZ, Zhang SJ
		hMex-3A is associated with poor prognosis and contributes to the progression of hepatocellular carcinoma ^Hot!
		Background: HMex-3A, an RNA-binding protein, was found to be associated with tumorigenesis. However, the roles of hMex-3A in hepatocellular carcinoma (HCC) progression remained unclear. Methods: The different expression of hMex-3A between HCC tissues and non-tumor tissues was evaluated using The Cancer Genome Atlas database. Thereafter, the hMex-3A expression was evaluated in HCC tissues using Western blotting and qRT-PCR. Immunohistochemistry was performed to investigate the association between hMex-3A level and clinicopathological features including prognosis in HCC patients. In addition, we used si-hMex-3A to knockdown hMex-3A in HCC cells to test Cell Counting Kit-8, colony formation, cell migration and invasion. Results: The hMex-3A expression was significantly elevated in HCC tissues. Analysis of the clinicopathological parameters suggested that hMex-3A expression was significantly associated with pathological grade ( P = 0.019) and TNM stage ( P = 0.001) in HCC. Moreover, univariate and multivariate Cox-regression analyses revealed that high hMex-3A expression (HR = 1.491, 95% CI: 1.107–2.007; P = 0.009) was an independent risk factor for overall survival in HCC patients. Finally, we confirmed that si-hMex-3A could significantly inhibit HCC cell proliferation, migration, and invasion in vitro. Conclusions: hMex-3A may contribute to the progression of HCC and might be used as a novel therapeutic target and prognostic marker in HCC.
		Hepatobiliary Pancreat Dis Int. 2021; 20(2): 147-153 . [Abstract] ( 116 ) [HTML 1KB] [PDF 0KB] ( 185 )

ORIGINAL ARTICLES/Biliary

	154	El-Araby HA, Saber MA, Radwan NM, Taie DM, Adawy NM, Sira AM
		SOX9 in biliary atresia: New insight for fibrosis progression
		Background: Liver fibrosis is a hallmark determinant of morbidity in biliary atresia (BA) even in successfully operated cases. Responsible factors for this rapid progression of fibrosis are not completely defined. Aberrant expression of the transcription factor SOX9 and hepatic progenitor cells (HPCs) proliferation have roles in fibrogenesis in cholestatic disorders. However, they were not investigated sufficiently in BA. We aimed to delineate the relation of SOX9 and HPCs to fibrosis and its progression in BA. Methods: Forty-eight patients with BA who underwent an initial diagnostic liver biopsy (LB) and consequent intraoperative LB were recruited and compared to 28 cases with non-BA cholestasis that had an LB in their diagnostic workup. Liver fibrosis, tissue SOX9 and HPC expressions were studied in both BA and non-BA-cholestasis cases. Liver fibrosis, SOX9, and HPCs’ dynamic changes in BA cases were assessed. Relation of fibrosis and its progression to SOX9 and HPCs in BA was assessed. Results: SOX9 and HPCs in ductular reaction (DR) form were expressed in 100% of BA and their grades increased significantly in the second biopsy. The rapidly progressive fibrosis in BA, represented by fibrosis grade of the intraoperative LB, correlated significantly to SOX9-DR and HPC-DR at the diagnostic (r = 0.420, P = 0.003 and r = 0.405, P = 0.004, respectively) and the intraoperative (r = 0.460, P = 0.001 and r = 0.467, P = 0.001, respectively) biopsy. On the other hand, fibrosis, SOX9-DR, and HPC-DR were significantly lower in non-BA cases at a comparable age (P < 0.001, P = 0.006, and P = 0.014, respectively). Conclusions: Fibrosis in BA is rapidly progressive within a short time and is significantly correlated to SOX9 and HPCs. Assessment of targeting SOX9 and HPCs on fibrosis progression is warranted.
		Hepatobiliary Pancreat Dis Int. 2021; 20(2): 154-162 . [Abstract] ( 99 ) [HTML 1KB] [PDF 0KB] ( 165 )

ORIGINAL ARTICLES/Pancreas

	163	Hua J, Chen XM, Chen YJ, Lu BC, Xu J, Wang W, Shi S, Yu XJ
		Development and multicenter validation of a nomogram for preoperative prediction of lymph node positivity in pancreatic cancer (NeoPangram) ^Hot!
		Background: Neoadjuvant therapy is associated with nodal downstaging and improved oncological outcomes in patients with lymph node (LN)-positive pancreatic cancer. This study aimed to develop and validate a nomogram to preoperatively predict LN-positive disease. Methods: A total of 558 patients with resected pancreatic cancer were randomly and equally divided into development and internal validation cohorts. Multivariate logistic regression analysis was used to construct the nomogram. Model performance was evaluated by discrimination, calibration, and clinical usefulness. An independent multicenter cohort consisting of 250 patients was used for external validation. Results: A four-marker signature was built consisting of carbohydrate antigen 19–9 (CA19–9), CA125, CA50, and CA242. A nomogram was constructed to predict LN metastasis using three predictors identified by multivariate analysis: risk score of the four-marker signature, computed tomography-reported LN status, and clinical tumor stage. The prediction model exhibited good discrimination ability, with C-indexes of 0.806, 0.742 and 0.763 for the development, internal validation, and external validation cohorts, respectively. The model also showed good calibration and clinical usefulness. A cut-offvalue (0.72) for the probability of LN metastasis was determined to separate low-risk and high-risk patients. Kaplan-Meier survival analysis revealed a good agreement of the survival curves between the nomogram-predicted status and the true LN status. Conclusions: This nomogram enables the identification of pancreatic cancer patients at high risk for LN positivity who may have more advanced disease and thus could potentially benefit from neoadjuvant therapy.
		Hepatobiliary Pancreat Dis Int. 2021; 20(2): 163-172 . [Abstract] ( 141 ) [HTML 1KB] [PDF 0KB] ( 156 )

	173	Shmelev A, Sill AM, Horrigan T, Cunningham SC
		Trends and seasonality in hospitalizations for acute alcohol-related and biliary pancreatitis in the USA
		Background: The incidence of acute pancreatitis (AP) is characterized by circannual and geographical variation. The aim of this study was to describe seasonal variation and trends in hospitalizations for AP in the USA with respect to AP etiology. Methods: The Nationwide Inpatient Sample data (2000–2016) from the Healthcare Cost and Utilization Project were used. The study population included all primary hospitalizations for AP. Biliary AP (BAP) and alcohol-induced AP (AAP) were distinguished by diagnostic and procedural ICD codes. Seasonal trend decomposition was performed. Results: There was a linear increase in annual incidence (per 100 000 population) of AAP in the USA (from 17.0 in 2000 to 22.9 in 2016), while incidence of BAP, equaled 19.9 in 2000, peaked at 22.1 in 2006 and decreased to 17.4 in 2016. AP incidence demonstrated 18% annual incidence amplitude with summer peak and winter trough, more prominent in AAP. In 2016, within AAP, the highest incidence (per 100 000 population) was noted among African-Americans (up to 50.4), followed by males aged 56–70 years (26.5) and Asians of low income (25.5); within BAP, above the average incidence was observed in Hispanic (up to 25.8) and Asian (up to 25.0) population. The most consistent and rapid increase in AP incidence was noted in males aged 56–70 years with an alcoholic etiology (average 6% annual incidence growth). Conclusions: The incidence and annual trends of AP vary significantly among demographic and socioeco- nomic groups and this knowledge may be useful for the planning of healthcare resources and identification of at-risk populations.
		Hepatobiliary Pancreat Dis Int. 2021; 20(2): 173-181 . [Abstract] ( 117 ) [HTML 1KB] [PDF 0KB] ( 171 )

	182	Sun YL, Gou JJ, Zhang KM, Li WQ, Ma XX, Zhou L, Zhu RT, Li J
		Complete resection of the gastric antrum decreased incidence and severity of delayed gastric emptying after pancreaticoduodenectomy
		Background: Delayed gastric emptying (DGE) is the main complication after pancreaticoduodenectomy (PD), but the mechanism is still unclear. The aim of this study was to elucidate the role of complete resection of the gastric antrum in decreasing incidence and severity of DGE after PD. Methods: Sprague-Dawley rats were divided into three groups: expanded resection (ER group), complete resection (CR group), and incomplete resection (IR group) of the gastric antrum. The tension (g) of remnant stomach contraction was observed. We analyzed the histological morphology of the gastric wall by different excisional methods after distal gastrectomy. Moreover, patients underwent PD at our department between January 2012 and May 2016 were included in the study. These cases were divided into IR group and CR group of the gastric antrum, and the clinical data were retrospectively analyzed. Results: The ex vivo remnant stomachs of CR group exhibited much greater contraction tension than others ( P < 0.05). The contraction tension of the remnant stomach increased with increasing acetylcholine concentration, while remained stable at the concentration of 10 ×10 −5 mol/L. Furthermore, 174 consecutive patients were included and retrospectively analyzed in the study. The incidence of DGE was significantly lower (3.5% vs. 21.3%, P < 0.01) in CR group than in IR group. In addition, hematoxylin-eosin staining analyses of the gastric wall confirmed that the number of transected circular smooth muscle bundles were higher in IR group than in CR group (8.24 ± 0.65 vs. 3.76 ± 0.70, P < 0.05). Conclusions: The complete resection of the gastric antrum is associated with decreased incidence and severity of DGE after PD. Gastric electrophysiological and physiopathological disorders caused by damage to gastric smooth muscles might be the mechanism underlying DGE.
		Hepatobiliary Pancreat Dis Int. 2021; 20(2): 182-189 . [Abstract] ( 108 ) [HTML 1KB] [PDF 0KB] ( 167 )

LETTERS TO THE EDITOR

	190	Jia JJ, Zhang SY, Yu J, Xie HY, Zhou L, Zheng SS
		The immune profiles and “minimizing tacrolimus” strategy for long-term survival recipients after liver transplantation
		Liver transplantation (LT) has become a major and effective therapeutic approach for end-stage liver disease [1]. However, 10-year graft and patient survival rates remained low with 54% and 61%, respectively [2]. Improving the outcome of long-term LT has become a major focus of the transplantation community.
		Hepatobiliary Pancreat Dis Int. 2021; 20(2): 190-192 . [Abstract] ( 116 ) [HTML 1KB] [PDF 0KB] ( 189 )

	193	Chan ACY, Dai WC, Chung PHY, She WH, Sin SL
		The ‘Unsigned highway’: An alternative route for portal vein anastomosis for non-malignant portal vein thrombosis during pediatric re-transplantation
		Non-malignant portal vein thrombosis (PVT) remains an important issue in liver transplantation due to the technical challenges in re-establishing the portal flow to the liver graft. The prevalence of complex PVT (i.e. Yerdel grade 4) was reported to be around 2.0% [1]. In the early history of liver transplantation, PVT was regarded as a contraindication. As knowledge and techniques improved over the years, different operative strategies have been derived, including direct endovenous thrombectomy [2], jump grafting to superior mesenteric vein (SMV) [3], and renoportal [4] or portocaval anastomosis [3]. However, the majority of these reports focused on flow restoration in adult recipients in whom cirrhosis with portal hypertension was the most common etiology. The wider caliber of mesenteric veins or the availability of shunts rendered such techniques feasible for portal flow restoration in adults. Nonetheless, this may not be possible in pediatric patients, given the size of the vessels, or the lack of spontaneous shunt formations [5]. We herein describe a novel, frequently unnoticed route for portal flow restoration.
		Hepatobiliary Pancreat Dis Int. 2021; 20(2): 193-195 . [Abstract] ( 101 ) [HTML 1KB] [PDF 0KB] ( 181 )

	196	Xie CH, Shen J, Zhang Q, Hu J, Gong FQ
		Acute cardiogenic liver injury caused by heart failure in an adolescent
		Heart failure is a systemic clinical syndrome characterized by multiple organ systems involvements [1]. With the progression of heart failure, patients may present with liver-related symptoms. However, these symptoms may be misdiagnosed as primary gastrointestinal diseases which lead to treatment delay and aggravation of conditions. We retrospectively reviewed the liver function changes in an adolescent with heart failure, which will help clinicians better understand acute cardiogenic liver injury.
		Hepatobiliary Pancreat Dis Int. 2021; 20(2): 196-197 . [Abstract] ( 114 ) [HTML 1KB] [PDF 0KB] ( 171 )

	198	Zhang J, Guo S, Mei TL, Zhou J, Guan DX, Wang GL
		Novel mutation of the TJP2 gene in a Chinese child with progressive cholestatic liver disease coexistent with hearing impairment
		Diagnosis and management of infantile cholestatic liver disease with unknown etiology remain challenging. With recent rapid development of genetic technology, several gene mutations have been found to be the cause of this disease [1]. Progressive familial intra- hepatic cholestasis (PFIC) is a group of rare diseases that mainly occur in neonates and infants. Some children might progress to end-stage liver disease that requires liver transplantation. Six types of PFICs have been identified. Previous reports have shown that mutations of ATP8B1 [2], ABCB11 [3], ABCB4 [4], TJP2 [5], NR1H4 [6], and MYO5B [7] are associated with PFIC 1–6. These genes partici- pate in different processes of bile transport.
		Hepatobiliary Pancreat Dis Int. 2021; 20(2): 198-200 . [Abstract] ( 105 ) [HTML 1KB] [PDF 0KB] ( 158 )

	201	Lim S, Kim CH, Paik KY, Kim W
		Double cystic duct without being aware of the anatomic anomaly during laparoscopic cholecystectomy: The first case of reverse Y type anomaly
		Variations in cystic duct anatomy are quite common, but double cystic ducts arising from one gallbladder is extremely rare, which have only been reported in less than 20 cases in literature [1–4]. It is difficult to diagnose the anatomic anomaly preoperatively, and the rate of open conversion and post-operation complications were high due to ductal injury during surgery [2]. Therefore, it is important for surgeons to recognize the anatomic variations preoperatively to prevent possible complications. In this case report, we presented an extremely rare case of a patient who had double cystic ducts and underwent cholecystectomy without being aware of the anatomic anomaly.
		Hepatobiliary Pancreat Dis Int. 2021; 20(2): 201-202 . [Abstract] ( 91 ) [HTML 1KB] [PDF 0KB] ( 189 )

	203	Takeshita K, Asai S, Fujimoto N, Ichinona T, Akamine E
		Comparison of the effects of retrieval balloons and basket catheters for bile duct stone removal on the rate of post-ERCP pancreatitis
		Endoscopic retrograde cholangiopancreatography (ERCP) is one of the most important techniques for diagnosis and treatment in pancreatobiliary medicine. Post-ERCP pancreatitis (PEP) is a common complication of ERCP with incidence about 3.8%-15.1% [1-4].
		Hepatobiliary Pancreat Dis Int. 2021; 20(2): 203-204 . [Abstract] ( 210 ) [HTML 1KB] [PDF 0KB] ( 170 )

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