Cholangitis, Sclerosing ; diagnosis ; therapy ; Humans

Cholangitis/therapy* ; Humans ; Liver Cirrhosis, Biliary/therapy*

Carcinoma ; complications ; therapy ; Cholangitis ; complications ; therapy ; Drainage ; Humans ; Semicircular Ducts

In 2015, the Chinese Society of Hepatology and Chinese Society of Gastroenterology issued a consensus on the diagnosis and management of primary biliary cholangitis (PBC). In the past years, more clinical studies have been reported in the field of PBC. To provide guidance to the clinical diagnosis and management of patients with PBC, the Chinese Society of Hepatology invited a panel of experts to assess the new clinical evidence and formulated the current guidelines which comprises 26 clinical recommendations.
Cholangitis/therapy* ; Consensus ; Gastroenterology ; Humans ; Liver Cirrhosis, Biliary/therapy*

Cholangitis ; diagnosis ; etiology ; therapy ; Humans ; Immunoglobulin G ; metabolism

Cholangitis, Sclerosing ; diagnosis ; therapy ; Hepatitis, Autoimmune ; diagnosis ; therapy ; Humans ; Liver Cirrhosis, Biliary ; diagnosis ; therapy

Autoimmune Diseases ; diagnosis ; etiology ; therapy ; Cholangitis ; diagnosis ; etiology ; therapy ; Diagnosis, Differential ; Humans

In the palliative setting, the necessity of biliary drainage of both liver lobes for malignant hilar biliary obstruction remains controversial. However, bilateral biliary drainage is a reasonable option to prevent cholangitis of the undrained lobe and to preserve liver function during the course of chemotherapy. Bilateral biliary drainage can be accomplished by the percutaneous or endoscopic placement of multiple self-expandable metallic stents (SEMS). Although SEMS placement via bilateral (multiple) percutaneous routes is technically simple, multiple percutaneous transhepatic biliary drainage (PTBD) may lead to additional morbidity. SEMS placement via a single percutaneous route is a useful method; however, negotiation of a guidewire into the contralateral bile duct is occasionally impossible if the hilar angle between the right hepatic duct and left hepatic duct is acute. Percutaneous dual SEMS placement is generally performed using the stent-in-stent technique (T configuration or Y configuration) or the side-by-side technique. In addition, the crisscross technique has been reported as being a useful method for trisegmental drainage. The side-to-end technique is also useful for multiple SEMS placement. In the future, the combination of percutaneous intervention and endoscopic ultrasonography-guided procedures may be effective in the management of malignant hilar biliary obstruction.
Bile Ducts ; Biliary Tract Neoplasms ; Cholangitis ; Drainage ; Drug Therapy ; Hepatic Duct, Common ; Liver ; Methods ; Negotiating ; Stents*

Biliary obstruction due to advanced hepatic hilar malignancy is difficult to treat, both surgically and non-surgically, using endoscopic or percutaneous drainage. Since only about 10% to 20% of patients are eligible for resection of hepatic hilar malignancies, most patients receive palliative rather than curative treatment. Percutaneous palliation of advanced hepatic hilar malignancies can be accomplished in a variety of ways. Percutaneous bilateral metallic stent placement may be a reasonable option in patients with hilar malignancies to preserve the functional volume of the liver during the course of chemotherapy and to prevent procedure-related cholangitis of a contaminated undrained lobe. Percutaneous bilateral stent-in-stent placement using wide-mesh or open-cell design stents is a feasible and effective method of achieving bilateral drainage. Moreover, unilateral covered or uncovered metallic stent placement in the lobe with patent portal vein is safe and effective method for palliative treatment in patients with contralateral portal vein occlusion caused by hilar malignancies, obviating the need for bilateral stent placement in these patients.
Bile Ducts, Intrahepatic ; Cholangitis ; Drainage ; Drug Therapy ; Humans ; Liver ; Methods ; Palliative Care ; Portal Vein ; Stents

Liver transplantation for treating cholangiocarcinoma (CCA) has potential benefits in terms of accomplishing radical resection even in patients with unresectable tumor and treating underlying disease such as primary sclerosing cholangitis (PSC). Despite this ideal rationale, the initial results of liver transplantation alone for CCA have been uniformly poor. Because of a high recurrence rate and a poor survival rate, CCA has been viewed as an absolute contraindication for transplantation. However, from the 1990s, liver transplantation following high dose neoadjuvant radiotherapy with chemotherapy has achieved excellent results, in a few medical centers, for selected patients with unresectable hilar CCA arising in the setting of PSC. Especially, the Mayo Clinic reported a 5-year survival rate of 73% for 120 patients in 2010 by performing neoadjuvant therapy and liver transplantation. We reviewed the results of liver transplantation in patients with hilar CCA and the protocol of the Mayo Clinic to consider the feasibility of liver transplantation for Korean patients with hilar CCA. Although liver transplantation with neoadjuvant therapy cannot be applied to most Korean patients due to the different disease entities and the good results with performing radical surgical resection, it can be considered as an alternative curative treatment option for selected patients with anatomically unresectable hilar CCA or CCA arising in the setting of PSC.
Cholangiocarcinoma ; Cholangitis, Sclerosing ; Humans ; Liver ; Liver Transplantation ; Neoadjuvant Therapy ; Recurrence ; Survival Rate ; Transplants