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Cordista V, Patel S, Lawson R, Lee G, Verheyen M, Westbrook A, Shelton N, Sapkota P, Zabala Valencia I, Gaddam C, Thomas J. Towards a Customizable, SLA 3D-Printed Biliary Stent: Optimizing a Commercially Available Resin and Predicting Stent Behavior with Accurate In Silico Testing. Polymers (Basel) 2024; 16:1978. [PMID: 39065295 PMCID: PMC11280906 DOI: 10.3390/polym16141978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2024] [Revised: 06/22/2024] [Accepted: 07/02/2024] [Indexed: 07/28/2024] Open
Abstract
Inflammation of the bile ducts and surrounding tissues can impede bile flow from the liver into the intestines. If this occurs, a plastic or self-expanding metal (SEM) stent is placed to restore bile drainage. United States (US) Food and Drug Administration (FDA)-approved plastic biliary stents are less expensive than SEMs but have limited patency and can occlude bile flow if placed spanning a duct juncture. Recently, we investigated the effects of variations to post-processing and autoclaving on a commercially available stereolithography (SLA) resin in an effort to produce a suitable material for use in a biliary stent, an FDA Class II medical device. We tested six variations from the manufacturer's recommended post-processing and found that tripling the isopropanol (IPA) wash time to 60 min and reducing the time and temperature of the UV cure to 10 min at 40 °C, followed by a 30 min gravity autoclave cycle, yielded a polymer that was flexible and non-cytotoxic. In turn, we designed and fabricated customizable, SLA 3D-printed polymeric biliary stents that permit bile flow at a duct juncture and can be deployed via catheter. Next, we generated an in silico stent 3-point bend test to predict displacements and peak stresses in the stent designs. We confirmed our simulation accuracy with experimental data from 3-point bend tests on SLA 3D-printed stents. Unfortunately, our 3-point bend test simulation indicates that, when bent to the degree needed for placement via catheter (~30°), the peak stress the stents are predicted to experience would exceed the yield stress of the polymer. Thus, the risk of permanent deformation or damage during placement via catheter to a stent printed and post-processed as we have described would be significant. Moving forward, we will test alternative resins and post-processing parameters that have increased elasticity but would still be compatible with use in a Class II medical device.
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Affiliation(s)
- Victoria Cordista
- School of Engineering, Mercer University, Macon, GA 31207, USA; (V.C.); (S.P.); (R.L.); (G.L.); (M.V.); (A.W.); (N.S.); (P.S.); (I.Z.V.); (C.G.)
- McKelvey School of Engineering, Washington University, St. Louis, MO 63114, USA
| | - Sagar Patel
- School of Engineering, Mercer University, Macon, GA 31207, USA; (V.C.); (S.P.); (R.L.); (G.L.); (M.V.); (A.W.); (N.S.); (P.S.); (I.Z.V.); (C.G.)
- Medical College of Georgia, Augusta University, Augusta, GA 30912, USA
| | - Rebecca Lawson
- School of Engineering, Mercer University, Macon, GA 31207, USA; (V.C.); (S.P.); (R.L.); (G.L.); (M.V.); (A.W.); (N.S.); (P.S.); (I.Z.V.); (C.G.)
| | - Gunhee Lee
- School of Engineering, Mercer University, Macon, GA 31207, USA; (V.C.); (S.P.); (R.L.); (G.L.); (M.V.); (A.W.); (N.S.); (P.S.); (I.Z.V.); (C.G.)
| | - Morgan Verheyen
- School of Engineering, Mercer University, Macon, GA 31207, USA; (V.C.); (S.P.); (R.L.); (G.L.); (M.V.); (A.W.); (N.S.); (P.S.); (I.Z.V.); (C.G.)
| | - Ainsley Westbrook
- School of Engineering, Mercer University, Macon, GA 31207, USA; (V.C.); (S.P.); (R.L.); (G.L.); (M.V.); (A.W.); (N.S.); (P.S.); (I.Z.V.); (C.G.)
| | - Nathan Shelton
- School of Engineering, Mercer University, Macon, GA 31207, USA; (V.C.); (S.P.); (R.L.); (G.L.); (M.V.); (A.W.); (N.S.); (P.S.); (I.Z.V.); (C.G.)
| | - Prakriti Sapkota
- School of Engineering, Mercer University, Macon, GA 31207, USA; (V.C.); (S.P.); (R.L.); (G.L.); (M.V.); (A.W.); (N.S.); (P.S.); (I.Z.V.); (C.G.)
| | - Isabella Zabala Valencia
- School of Engineering, Mercer University, Macon, GA 31207, USA; (V.C.); (S.P.); (R.L.); (G.L.); (M.V.); (A.W.); (N.S.); (P.S.); (I.Z.V.); (C.G.)
| | - Cynthia Gaddam
- School of Engineering, Mercer University, Macon, GA 31207, USA; (V.C.); (S.P.); (R.L.); (G.L.); (M.V.); (A.W.); (N.S.); (P.S.); (I.Z.V.); (C.G.)
| | - Joanna Thomas
- School of Engineering, Mercer University, Macon, GA 31207, USA; (V.C.); (S.P.); (R.L.); (G.L.); (M.V.); (A.W.); (N.S.); (P.S.); (I.Z.V.); (C.G.)
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Khalifa MO, Yan C, Chai Y, Ito K, Zhang SH, Li TS. Hydrostatic pressure mediates epithelial-mesenchymal transition of cholangiocytes through RhoA/ROCK and TGF-β/smad pathways. PLoS One 2024; 19:e0300548. [PMID: 38578740 PMCID: PMC10997127 DOI: 10.1371/journal.pone.0300548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2024] [Accepted: 02/28/2024] [Indexed: 04/07/2024] Open
Abstract
Biomechanical cue within the tissue microenvironment is known to play a critical role in regulating cell behaviors and maintaining tissue homeostasis. As hydrostatic pressure often increases in biliary system under pathological states, we investigated the effect of the moderate elevation of the hydrostatic pressure on biliary epithelial cells, especially on the epithelial-mesenchymal transition (EMT). Human intrahepatic biliary epithelial cells were loaded to hydrostatic pressure using a commercial device. We found that loading the cells to 50 mmHg hydrostatic pressure induced obvious morphological changes and significantly upregulated vimentin, ZEB1, and pSmad2/3, fibronectin, and collagen 1α. All changes induced by hydrostatic pressure loading were effectively mitigated by either ROCK inhibitor (Y-27632) or ALK5 inhibitor (SB-431542). Our in vitro experimental data suggests that hydrostatic pressure loading induces EMT of cholangiocytes through RhoA/ROCK and TGF-β/Smad pathways. Elevated hydrostatic pressure in biliary duct system under pathological states may promote the biliary epithelial cells shifting to profibrotic and mesenchymal characteristics.
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Affiliation(s)
- Mahmoud Osman Khalifa
- Department of Stem Cell Biology, Atomic Bomb Disease Institute, Nagasaki University, Nagasaki, Japan
- Department of Molecular Bone Biology, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan
- Department of Anatomy and Embryology, Veterinary Medicine, Aswan University, Aswan, Egypt
| | - Chen Yan
- Department of Stem Cell Biology, Atomic Bomb Disease Institute, Nagasaki University, Nagasaki, Japan
| | - Yong Chai
- Department of General Surgery, Jiangxi Provincial Children’s Hospital, Nanchang, Jiangxi, China
| | - Kosei Ito
- Department of Molecular Bone Biology, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan
| | - Shou-Hua Zhang
- Department of General Surgery, Jiangxi Provincial Children’s Hospital, Nanchang, Jiangxi, China
| | - Tao-Sheng Li
- Department of Stem Cell Biology, Atomic Bomb Disease Institute, Nagasaki University, Nagasaki, Japan
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Zhu L, Su W, Xu X, Shao S, Qin C, Gao R, Wang X, Ma M, Gao J, Zhang Z. Sphincter of Oddi Dysfunction Induces Gallstone by Inhibiting the Expression of ABCB11 via PKC-α. Appl Biochem Biotechnol 2023:10.1007/s12010-023-04818-x. [PMID: 38158489 DOI: 10.1007/s12010-023-04818-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/19/2023] [Indexed: 01/03/2024]
Abstract
The abnormal increase of Oddi sphincter pressure and total bile duct pressure may play an important role in the formation of cholesterol stones, but the specific molecular mechanism is still unclear. This study aims to investigate it through in vitro and in vivo experiments. A mouse model of Oddi sphincter dysfunction was constructed by stone-inducing diet. We compared the two groups with PKC-α inhibitor GÖ6976 and PKC-α agonist thymeleatoxin. Oddi sphincter pressure and total bile duct pressure were measured. Biochemical analysis of total cholesterol, bile acid and bilirubin was then conducted. The histopathologic changes of bile duct were observed by HE staining and the ultrastructure of liver cells and surrounding tissues was observed by transmission electron microscopy. Through the above experiments, we found that the change of PKC-α expression may affect the formation process of gallstones. The relationship between PKC-α and ABCB11 was further verified by in vitro and in vivo experiments. Our results suggest that ABCB11 and PKC-α are co-expressed in the tubule membrane of hepatocytes and interact with each other in hepatocytes. The high cholesterol diet further enhances the activation of PKC-α and thus reduces the expression of ABCB11. The formation of cholesterol stones is associated with the down-regulation of ABCB11 expression in the tubule membrane of hepatocytes due to kinase signaling. This is the first study to demonstrate that sphincter of Oddi dysfunction induces gallstones through PKC-α inhibition of ABCB11 expression.
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Affiliation(s)
- Lichao Zhu
- Department of Pediatric Surgery, Shandong Provincial Hospital, Shandong University , Jinan, 250021, China
| | - Wei Su
- Liver Gall Bladder and Pancreatic Surgery Ward, Qinghai Red Cross Hospital, Xining, 810001, China
| | - Xianwen Xu
- Department of Hepatobiliary Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, 250021, China
| | - Shuai Shao
- Department of Hepatobiliary Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, 250021, China
| | - Chuan Qin
- Department of Hepatobiliary Surgery, Shandong Provincial Hospital, Shandong University, 250021, Jinan, China
| | - Ruxin Gao
- Department of Hepatobiliary Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, 250021, China
| | - Xinxing Wang
- Department of Hepatobiliary Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, 250021, China
| | - Mingze Ma
- Departments of Infectious Diseases, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, 250021, China
| | - Junlin Gao
- Liver Gall Bladder and Pancreatic Surgery Ward, Qinghai Red Cross Hospital, Xining, 810001, China.
| | - Zhenhai Zhang
- Department of Hepatobiliary Surgery, Shandong Provincial Hospital, Shandong University, 250021, Jinan, China.
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Nishiwaki R, Imoto I, Oka S, Yasuma T, Fujimoto H, D'Alessandro-Gabazza CN, Toda M, Kobayashi T, Osamu H, Fujibe K, Nishikawa K, Hamaguchi T, Sugimasa N, Noji M, Ito Y, Takeuchi K, Cann I, Inoue Y, Kato T, Gabazza EC. Elevated plasma and bile levels of corisin, a microbiota-derived proapoptotic peptide, in patients with severe acute cholangitis. Gut Pathog 2023; 15:59. [PMID: 38037145 PMCID: PMC10688013 DOI: 10.1186/s13099-023-00587-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 11/21/2023] [Indexed: 12/02/2023] Open
Abstract
BACKGROUND Acute cholangitis is a severe, life-threatening infection of the biliary system that requires early diagnosis and treatment. The Tokyo Guidelines recommend a combination of clinical, laboratory, and imaging findings for diagnosis and severity assessment, but there are still challenges in identifying severe cases that need immediate intervention. The microbiota and its derived products have been implicated in the pathogenesis of acute cholangitis. Corisin is a microbiome-derived peptide that induces cell apoptosis, acute tissue injury, and inflammation. This study aimed to evaluate the potential of plasma and bile corisin as a biomarker of acute cholangitis. METHODS Forty patients with acute cholangitis associated with choledocholithiasis or malignant disease were enrolled. Nine patients without acute cholangitis were used as controls. Corisin was measured by enzyme immunoassays in plasma and bile samples. Patients were classified into severe and non-severe groups. The associations of plasma and bile corisin with the clinical grade of acute cholangitis and other parameters were analyzed by univariate and multivariate regression analysis. RESULTS Plasma and bile corisin levels were significantly higher in patients with acute cholangitis than in controls. Patients with severe acute cholangitis had significantly higher plasma and bile corisin levels than those with non-severe form of the disease. Bile corisin level was significantly correlated with markers of inflammation, coagulation, fibrinolysis, and renal function. Univariate analysis revealed a significant association of bile corisin but a weak association of plasma corisin with the clinical grade of acute cholangitis. In contrast, multivariate analysis showed a significant relationship between plasma corisin level and the disease clinical grade. The receiver operating characteristic curve analysis showed low sensitivity but high specificity for plasma and bile corisin to detect the severity of acute cholangitis. The plasma and bile corisin sensitivity was increased when serum C-reactive protein level was included in the receiver operating characteristic curve analysis. CONCLUSIONS Overall, these findings suggest that plasma and bile corisin levels may be useful biomarkers for diagnosing and monitoring acute cholangitis and that corisin may play a role in the pathophysiology of the disease by modulating inflammatory, coagulation and renal pathways.
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Affiliation(s)
- Ryo Nishiwaki
- Digestive Endoscopy Center, Doshinkai Tohyama Hospital, Minamishinmachi 17-22, Tsu, Mie, 514-0043, Japan
- Department of Surgery, Doshinkai Tohyama Hospital, Minamishinmachi 17-22, Tsu, Mie, 514-0043, Japan
| | - Ichiro Imoto
- Digestive Endoscopy Center, Doshinkai Tohyama Hospital, Minamishinmachi 17-22, Tsu, Mie, 514-0043, Japan
| | - Satoko Oka
- Department of Internal Medicine, Doshinkai Tohyama Hospital, Minamishinmachi 17-22, Tsu, Mie, 514-0043, Japan
| | - Taro Yasuma
- Microbiome Research Center, Mie University, Edobashi 2-174, Tsu, Mie, 514-8507, Japan
- Department of Immunology, Mie University Faculty and Graduate School of Medicine, Mie University Hospital, Edobashi 2-174, Tsu, Mie, 514-8507, Japan
| | - Hajime Fujimoto
- Microbiome Research Center, Mie University, Edobashi 2-174, Tsu, Mie, 514-8507, Japan
- Department of Pulmonary and Critical Care Medicine, Mie University Faculty and Graduate School of Medicine, Mie University Hospital, Edobashi 2-174, Tsu, Mie, 514-8507, Japan
| | - Corina N D'Alessandro-Gabazza
- Carl R. Woese Institute for Genomic Biology (Microbiome Metabolic Engineering), University of IL at Urbana-Champaign, Urbana, IL, USA
- Department of Immunology, Mie University Faculty and Graduate School of Medicine, Mie University Hospital, Edobashi 2-174, Tsu, Mie, 514-8507, Japan
| | - Masaaki Toda
- Department of Immunology, Mie University Faculty and Graduate School of Medicine, Mie University Hospital, Edobashi 2-174, Tsu, Mie, 514-8507, Japan
| | - Tetsu Kobayashi
- Microbiome Research Center, Mie University, Edobashi 2-174, Tsu, Mie, 514-8507, Japan
- Department of Pulmonary and Critical Care Medicine, Mie University Faculty and Graduate School of Medicine, Mie University Hospital, Edobashi 2-174, Tsu, Mie, 514-8507, Japan
| | - Hataji Osamu
- Respiratory Center, Matsusaka Municipal Hospital, Tonomachi1550, Matsusaka, Mie, 515-8544, Japan
| | - Kodai Fujibe
- Department of Gastroenterology, Matsusaka Municipal Hospital, Tonomachi1550, Matsusaka, Mie, 515-8544, Japan
| | - Kenichiro Nishikawa
- Department of Gastroenterology, Matsusaka Municipal Hospital, Tonomachi1550, Matsusaka, Mie, 515-8544, Japan
| | - Tetsuya Hamaguchi
- Department of Surgery, Doshinkai Tohyama Hospital, Minamishinmachi 17-22, Tsu, Mie, 514-0043, Japan
| | - Natsuko Sugimasa
- Department of Surgery, Doshinkai Tohyama Hospital, Minamishinmachi 17-22, Tsu, Mie, 514-0043, Japan
| | - Midori Noji
- Department of Surgery, Doshinkai Tohyama Hospital, Minamishinmachi 17-22, Tsu, Mie, 514-0043, Japan
| | - Yoshiyuki Ito
- Department of Surgery, Doshinkai Tohyama Hospital, Minamishinmachi 17-22, Tsu, Mie, 514-0043, Japan
| | - Kenji Takeuchi
- Department of Surgery, Doshinkai Tohyama Hospital, Minamishinmachi 17-22, Tsu, Mie, 514-0043, Japan
| | - Isaac Cann
- Carl R. Woese Institute for Genomic Biology (Microbiome Metabolic Engineering), University of IL at Urbana-Champaign, Urbana, IL, USA
- Department of Microbiology, The University of IL at Urbana-Champaign, Urbana, IL, USA
- Department of Animal Science, University of Illinois Urbana-Champaign, Urbana, IL, 61801, USA
| | - Yasuhiro Inoue
- Department of Surgery, Doshinkai Tohyama Hospital, Minamishinmachi 17-22, Tsu, Mie, 514-0043, Japan
| | - Toshio Kato
- Department of Surgery, Doshinkai Tohyama Hospital, Minamishinmachi 17-22, Tsu, Mie, 514-0043, Japan
| | - Esteban C Gabazza
- Microbiome Research Center, Mie University, Edobashi 2-174, Tsu, Mie, 514-8507, Japan.
- Carl R. Woese Institute for Genomic Biology (Microbiome Metabolic Engineering), University of IL at Urbana-Champaign, Urbana, IL, USA.
- Department of Immunology, Mie University Faculty and Graduate School of Medicine, Mie University Hospital, Edobashi 2-174, Tsu, Mie, 514-8507, Japan.
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Mayer C, Nehring S, Kücken M, Repnik U, Seifert S, Sljukic A, Delpierre J, Morales‐Navarrete H, Hinz S, Brosch M, Chung B, Karlsen T, Huch M, Kalaidzidis Y, Brusch L, Hampe J, Schafmayer C, Zerial M. Apical bulkheads accumulate as adaptive response to impaired bile flow in liver disease. EMBO Rep 2023; 24:e57181. [PMID: 37522754 PMCID: PMC10481669 DOI: 10.15252/embr.202357181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 07/11/2023] [Accepted: 07/13/2023] [Indexed: 08/01/2023] Open
Abstract
Hepatocytes form bile canaliculi that dynamically respond to the signalling activity of bile acids and bile flow. Little is known about their responses to intraluminal pressure. During embryonic development, hepatocytes assemble apical bulkheads that increase the canalicular resistance to intraluminal pressure. Here, we investigate whether they also protect bile canaliculi against elevated pressure upon impaired bile flow in adult liver. Apical bulkheads accumulate upon bile flow obstruction in mouse models and patients with primary sclerosing cholangitis (PSC). Their loss under these conditions leads to abnormally dilated canaliculi, resembling liver cell rosettes described in other hepatic diseases. 3D reconstruction reveals that these structures are sections of cysts and tubes formed by hepatocytes. Mathematical modelling establishes that they positively correlate with canalicular pressure and occur in early PSC stages. Using primary hepatocytes and 3D organoids, we demonstrate that excessive canalicular pressure causes the loss of apical bulkheads and formation of rosettes. Our results suggest that apical bulkheads are a protective mechanism of hepatocytes against impaired bile flow, highlighting the role of canalicular pressure in liver diseases.
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Affiliation(s)
- Carlotta Mayer
- Max Planck Institute of Molecular Cell Biology and GeneticsDresdenGermany
| | - Sophie Nehring
- Department of Medicine I, Gastroenterology and HepatologyUniversity Hospital Carl‐Gustav‐Carus, Technische Universität Dresden (TU Dresden)DresdenGermany
| | - Michael Kücken
- Center for Information Services and High‐Performance ComputingTechnische Universität DresdenDresdenGermany
| | - Urska Repnik
- Central Microscopy, Department of BiologyChristian‐Albrechts‐Universtät zu Kiel (CAU)KielGermany
| | - Sarah Seifert
- Max Planck Institute of Molecular Cell Biology and GeneticsDresdenGermany
| | - Aleksandra Sljukic
- Max Planck Institute of Molecular Cell Biology and GeneticsDresdenGermany
| | - Julien Delpierre
- Max Planck Institute of Molecular Cell Biology and GeneticsDresdenGermany
| | | | - Sebastian Hinz
- Department of General SurgeryUniversity Hospital RostockRostockGermany
| | - Mario Brosch
- Department of Medicine I, Gastroenterology and HepatologyUniversity Hospital Carl‐Gustav‐Carus, Technische Universität Dresden (TU Dresden)DresdenGermany
- Center for Regenerative Therapies Dresden (CRTD)Technische Universität Dresden (TU Dresden)DresdenGermany
| | - Brian Chung
- Department of Transplantation Medicine, Clinic of Surgery, Inflammatory Medicine and Transplantation, Norwegian PSC Research CenterOslo University Hospital RikshospitaletOsloNorway
- Research Institute of Internal Medicine, Clinic of Surgery, Inflammatory Diseases and TransplantationOslo University Hospital and University of OsloOsloNorway
| | - Tom Karlsen
- Department of Transplantation Medicine, Clinic of Surgery, Inflammatory Medicine and Transplantation, Norwegian PSC Research CenterOslo University Hospital RikshospitaletOsloNorway
- Research Institute of Internal Medicine, Clinic of Surgery, Inflammatory Diseases and TransplantationOslo University Hospital and University of OsloOsloNorway
| | - Meritxell Huch
- Max Planck Institute of Molecular Cell Biology and GeneticsDresdenGermany
| | - Yannis Kalaidzidis
- Max Planck Institute of Molecular Cell Biology and GeneticsDresdenGermany
| | - Lutz Brusch
- Center for Information Services and High‐Performance ComputingTechnische Universität DresdenDresdenGermany
| | - Jochen Hampe
- Department of Medicine I, Gastroenterology and HepatologyUniversity Hospital Carl‐Gustav‐Carus, Technische Universität Dresden (TU Dresden)DresdenGermany
- Center for Regenerative Therapies Dresden (CRTD)Technische Universität Dresden (TU Dresden)DresdenGermany
| | | | - Marino Zerial
- Max Planck Institute of Molecular Cell Biology and GeneticsDresdenGermany
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Bile Flow Dynamics in Patients with Cholelithiasis: An Evaluation with Cine-Dynamic Magnetic Resonance Cholangiopancreatography Using a Spatially Selective Inversion-Recovery Pulse. Tomography 2022; 8:815-823. [PMID: 35314644 PMCID: PMC8938776 DOI: 10.3390/tomography8020067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 03/08/2022] [Accepted: 03/14/2022] [Indexed: 11/29/2022] Open
Abstract
Background: A variety of pathophysiological changes in the biliary system occur in patients with cholelithiasis, but the changes in the bile flow dynamics in those patients remain unclear. The purpose of this study was to elucidate the changes in the bile flow dynamics in patients with cholelithiasis using cine-dynamic magnetic resonance cholangiopancreatography (MRCP) with a spatially selective inversion-recovery (IR) pulse. Methods: We retrospectively examined 25 patients with gallstones (gallstone group) and 69 patients without gallstones (non-gallstone group) who underwent abdominal MRI, including in- and opposed-phase T1-weighted images and cine-dynamic MRCP with a spatially selective IR pulse. The frequency and secretion grade of the antegrade and reverse flow of the bile on the cine dynamic MRCP images and the signal intensity ratio (SIR) of the gallbladder in the in- and opposed-phase T1-weighted images were evaluated. Results: The frequency and mean secretion grade of the antegrade bile flow were significantly higher in the gallstone group than in the non-gallstone group (p = 0.011 and p = 0.003), while no significant differences in those values of the reverse bile flow were found between the two groups. The SIR of the gallbladder in the T1-weighted gradient-echo in-phase images was significantly lower in the gallstone group than in the non-gallstone group (p = 0.004). Conclusions: Cine-dynamic MRCP with a spatially selective IR pulse can noninvasively visualize changes in the bile flow dynamics of patients with gallstones.
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Abstract
INTRODUCTION Cholecystectomy is the preferred option for symptomatic gallstones. Gallbladder-preserving cholecystolithotomy (GPC) is proposed to satisfy the specific surgical patients with high-risks, biliary deformity and suffered from concomitant gallstone and choledocholithiasis. AREAS COVERED This review summarizes and compares the various GPC operations for cholelithiasis in some specific cases. EXPERT OPINION Transmural GPC mainly focuses on the gallstones, including endoscopic minimally invasive cholecystolithotomy (EMIC)-, natural orifice transluminal endoscopic surgery-, and endoscopic ultrasonography (EUS)-GPC. These GPC procedures potentially preserve gallbladder integrity and function after clearance of gallstones. Additionally, transmural GPC may overcome the disadvantages of cholecystectomy, including cosmetic considerations and postoperative complications. However, the stone recurrence rate of EMIC varies greatly from 4.92% to 40.0%, and based on limited studies, long-term adverse events due to gallbladder mucosa and natural lumen injury are largely unknown in transmural GPC. Thus, transmural GPC may be an alternative to cholecystectomy for surgical patients with high-risks and abnormal biliary anatomy. Endoscopic retrograde cholangiopancreatography-based transcystic GPC may be promising for some specific patients with concomitant gallstones and choledocholithiasis, since gallbladder integrity and function may be completely preserved as the gallbladder wall was hardly injured and the function of sphincter of Oddi was retained.
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Affiliation(s)
- Yuanzhen Hao
- Department of Gastroenterology, First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China.,Department of Gastroenterology, Beijing Friendship Hospital, Capital Medical University, Beijing, Hebei, China
| | - Zhenzhen Yang
- Department of Gastroenterology, First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Hui Yang
- Department of Gastroenterology, First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Junbo Hong
- Department of Gastroenterology, First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
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Wang Y, Jie J, Qian B, Qiao Y, Yu P, Zhang J. Analysis of the Relationship Between Periampullary Diverticulum and Recurrent Bile Duct Stones After Endoscopy on Magnetic Resonance Imaging of Magnetic Nanoparticles. J Biomed Nanotechnol 2022; 18:607-615. [PMID: 35484733 DOI: 10.1166/jbn.2022.3270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
The objective of this work was to investigate the effect of magnetic resonance cholangiopancreatography (MRCP) based on super-paramagnetic iron oxide nanoparticles (SPIONs) on the recurrence diagnosis of periampullary diverticulum (PAD) and bile duct stone (BDS), so as to provide a scientific research basis for the recidivation factors of bile duct stones in clinic. Patients with PAD diagnosed in hospital from July 2019 to March 2021 (who had undergone endoscopic gallstone surgery) were selected for study in this work. They were rolled into two groups, the parapapillary group (123 cases) and the cholangiopancreatic duct directly opening in the diverticulum group (97 cases), according to the clinical classification. Then, 100 patients without PAD who had undergone bile duct node therapy were selected as the control group. The recidivation of BDS, serological index, and biliary pressure index before and after treatment were compared. The relationship between PAD and recidivation of bile duct stones was analyzed. The results showed that the average particle size, hydration kinetic particle size, effective time, and duration of polyethylene glycol (PEG)/polyethyleneimine (PEI)/poly aspartic acid-super-paramagnetic iron oxide nanoparticles(PASP-SPIONs) were better than PEG/PEI-SPIONs and SPIONs. The recidivation rate of BDS in Groups R and X was remarkably higher than the rate in control group (P < 0.05). Before treatment, common bile duct pressure in the control group was lower obviously than that in Groups R and X (P < 0.05). After treatment, the indexes including total bilirubin, direct bilirubin, and alkaline phosphatase in control group were lower than those in Groups R and X (P < 0.05). The incidence of complications in Groups R and X was much higher than in contrast to the control group (P < 0.05). Therefore, PEG/PEI/PASP-SPIONs had good contrast effect and could be used as magnetic resonance imaging contrast agent. Complications such as common bile duct pressure and infection were increased by PAD, which may be the main factor for the recidivation of BDS.
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Affiliation(s)
- Yingkai Wang
- Department of Hepatobiliary Pancreatic Surgery and Liver Transplantation Center, The First Hospital of Shanxi Medical University, Taiyuan, 030000, China
| | - Jiepeng Jie
- Department of General Surgery, General Hospital of Taiyuan Iron and steel (Group) Co. Ltd., Taiyuan, 030003, China
| | - Bo Qian
- Department of General Surgery, General Hospital of Taiyuan Iron and steel (Group) Co. Ltd., Taiyuan, 030003, China
| | - Yongping Qiao
- Department of General Surgery, General Hospital of Taiyuan Iron and steel (Group) Co. Ltd., Taiyuan, 030003, China
| | - Pengming Yu
- Department of General Surgery, General Hospital of Taiyuan Iron and steel (Group) Co. Ltd., Taiyuan, 030003, China
| | - Jijun Zhang
- Department of Hepatobiliary Pancreatic Surgery and Liver Transplantation Center, The First Hospital of Shanxi Medical University, Taiyuan, 030000, China
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9
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Nakahara K, Michikawa Y, Suetani K, Sato J, Igarashi Y, Sekine A, Kobayashi S, Matsuda K, Otsubo T, Itoh F. Efficacy of endoscopic large balloon dilation extended for 2 minutes in bile duct stone removal: A multicenter retrospective study. JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES 2021; 29:932-940. [PMID: 34329520 DOI: 10.1002/jhbp.1029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 07/20/2021] [Accepted: 07/26/2021] [Indexed: 12/07/2022]
Abstract
BACKGROUND/PURPOSE There is no evidence regarding the optimal balloon dilation time during endoscopic papillary large balloon dilation (EPLBD). The study aim was to evaluate the efficacy of 2-minute extended balloon dilation for EPLBD. METHODS Two hundred and five patients who underwent EPLBD during endoscopic retrograde cholangiopancreatography (ERCP) for bile duct stones at three tertiary centers were included in the analysis. Clinical outcomes and the adverse events were compared between the 0-minute group (n = 94, balloon deflated immediately after waist disappearance) and the 2-minute group (n = 111, balloon dilation maintained for 2 minutes after waist disappearance). The risk factors of post-ERCP pancreatitis (PEP) after EPLBD were assessed. RESULTS There were no significant differences in the stone removal rates and hospitalization periods between the two groups. However, the total ERCP procedure time was significantly shorter in the 2-minute group (40.6 vs 48.9 min, P = .03). The incidence of PEP was 7.4% in the 0-minute group and significantly lower at 0.9% in the 2-minute group (P = .04). Multivariate analysis identified without 2-minute extended EPLBD as a significant risk factor of PEP (OR: 9.9, P = .045). CONCLUSIONS Extension of EPLBD for 2 minutes helped prevent PEP and shortened the procedure time.
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Affiliation(s)
- Kazunari Nakahara
- Department of Gastroenterology and Hepatology, School of Medicine, St. Marianna University, Kawasaki, Japan
| | - Yosuke Michikawa
- Department of Gastroenterology and Hepatology, School of Medicine, St. Marianna University, Kawasaki, Japan
| | - Keigo Suetani
- Department of Gastroenterology and Hepatology, Kawasaki Municipal Tama Hospital, Kawasaki, Japan
| | - Junya Sato
- Department of Gastroenterology and Hepatology, School of Medicine, St. Marianna University, Kawasaki, Japan
| | - Yosuke Igarashi
- Department of Gastroenterology and Hepatology, School of Medicine, Yokohama City Seibu Hospital, St. Marianna University, Yokohama, Japan
| | - Akihiro Sekine
- Department of Gastroenterology and Hepatology, School of Medicine, St. Marianna University, Kawasaki, Japan
| | - Shinjiro Kobayashi
- Department of Gastroenterogical and General Surgery, School of Medicine, St. Marianna University, Kawasaki, Japan
| | - Koji Matsuda
- Department of Gastroenterology, Shizuoka Medical Center, Shizuoka, Japan
| | - Takehito Otsubo
- Department of Gastroenterogical and General Surgery, School of Medicine, St. Marianna University, Kawasaki, Japan
| | - Fumio Itoh
- Department of Gastroenterology and Hepatology, School of Medicine, St. Marianna University, Kawasaki, Japan
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