Background/Aims: Bilateral endoscopic drainage with self-expanding metallic stent (SEMS) can be used to effectively manage hilar malignant biliary obstruction. However, the benefits of using a trisegment drainage method remain unknown. Methods:This study retrospectively reviewed the data of 125 patients with Bismuth type IIIa or IV unresectable malignant strictures who underwent bilateral endoscopic drainage using SEMSs at four tertiary centers. The patients were divided into the bilateral and trisegment drainage groups for comparison. The primary endpoint was stent patency and the secondary endpoints were technical success, technical and clinical success of reintervention, and overall survival. Results:The technical success rates of the bilateral and trisegment drainage groups were 95% (34/36) and 90% (80/89) (p=0.41), respectively, with median stent patency durations of 226 and 170 days (p=0.26), respectively. Although the technical success of reintervention was not significantly different between the two groups (p=0.51), the clinical success rate of reintrvention was significantly higher in the trisegment drainage group (73% [11/15] vs 96% [47/49], p=0.009). The median survival times were 324 and 323 days in the bilateral and trisegment drainage groups, respectively (p=0.72). Multivariate Cox hazards model revealed no stent patency-associated factor; however, chemotherapy was associated with longer survival. Conclusions:Although no significant difference was noted with respect to stent patency, significantly higher clinical success rates were achieved with reintervention using the trisegment drainage method than using the bilateral drainage method alone.
Background and Purpose The progression of fibrosis is recently acknowledged as an important phenomenon in the progression of non-alcoholic fatty liver disease (NAFLD). Standard markers reflecting liver fibrosis (e.g., FIB-4 index or NFS) have been shown to increase with age. This study aimed to identify fibrosis progression-related markers that are beneficial even in aged individuals. Methods A study population of 98 patients diagnosed with NAFLD (non-alcoholic fatty liver [NAFL], n=25; non-alcoholic steatohepatitis [NASH], n=73). Their fibrosis stages were as follows: stage 1 (n=25), stage 2 (n=35), stage 3 (n=33), stage 4 (n=10). Serum levels of pro-inflammatory and anti-inflammatory cytokines were measured by a multiple enzyme-linked immunosorbent assay. Cytokines, the FIB-4 index, and APRI were analyzed to define the best approach to discriminate advanced NAFLD, even in aged (>65 years old) patients. Results The following markers showed significant differences between NAFL and NASH: FIB-4, APRI, IP-10, VEGF, and IL-15. The following markers showed significant differences between stage 1-2 and stage 3-4: FIB-4, APRI, IP-10, VEGF, IL-17, PDGF-BB, and RANTES. The fibrosis stage, FIB-4, APRI, PDGF-BB and RANTES were related to the prognosis. In aged patients, IP-10, GM-CSF, RANTES differed between stage 1-2 and stage 3-4. Conclusion FIB-4 or APRI, standard NAFLD or fibrosis progression-related markers were beneficial not only for their correlation with fibrosis but also for predicting the prognosis. However, in aged patients, the correlation diminished and RANTES (a chemokine) showed all correlations and should be regarded as beneficial marker in NAFLD.
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