Our retrospective analysis did not demonstrate the advantage of ENBD over EBS as the initial PBD for resectable hilar MBO. Although the technical success rate of endoscopic PBD was high, its re-intervention rate was not negligible, and unplanned re-intervention was associated with a poor prognosis in resected hilar MBO.

An 86-year-old woman from Japan was admitted to our hospital with jaundice. Endoscopic ultrasonography (EUS) revealed a highechoic wall thickening and mass lesion with an irregular or papillary surface in the gallbladder. Moreover, mobile hyperechoic lesions were observed in the gallbladder and common bile duct. Contrast-enhanced EUS showed inhomogeneous hyperenhancement patterns within the gallbladder wall thickening and mass lesion without any invasion out of the gallbladder wall (Figure 1). The opening of the papilla of Vater and outflow of mucus from the papilla were endoscopically confirmed. Endoscopic retrograde cholangiography showed filling defects within the dilated common bile duct, with slight movement and changes in shape. Peroral cholangioscopy (POCS) showed the mucinous material continued to flow out of the cystic duct and no obvious tumor in cystic and common bile duct (Figure 2). Based on these findings, intracholecystic papillary neoplasm (ICPN) localized in the gallbladder and jaundice due to mucinous production was diagnosed, and laparoscopic cholecystectomy was performed without extended surgical resection.

Background The sensitivity of bile cytology for malignant biliary strictures is not adequate. To overcome this limitation, we evaluated whether quantitative analysis of microRNAs (miRNAs) in bile can provide a precise diagnosis of malignant biliary strictures due to pancreatic cancer (PC) and biliary tract cancer (BTC). Methods This was a retrospective evaluation of miRNA levels in stored bile samples of patients with PC, BTC or benign biliary stricture obtained during biliary drainage from April 2019 to December 2021 at our institution. A total of 113 patients (PC; n = 40, BTC; n = 38, control; n = 35) were enrolled. The miRNA candidates to be quantified were determined with microarray analysis from each 3 patients with PC, BTC and controls. Results Using microarray analysis, we confirmed four significantly up-regulated miRNAs (miR-1275, miR-6891-5p, miR-7107-5p, miR-3197) in patients with PC and BTC compared to control patients. Quantitative PCR was then performed in 113 bile samples for these miRNAs. miR-1275 was significantly upregulated in PC (p = 0.003) and BTC (p = 0.049) compared to controls, miR-6891-5p was significantly upregulated in PC compared to controls (p = 0.025). In particular, a combination of bile cytology and miR-1275 in bile showed a sensitivity of 77.5% (95% CI, 70.7–77.5%), specificity of 100% (95% CI, 92.2–100%) and an area under the curve (AUC) of 0.93, and provided a significantly greater additional diagnostic effect than bile cytology alone (p = 0.014). Conclusions This study suggest that bile miRNAs could be potential biomarkers for pancreato-biliary diseases, particularly miR-1275 and miR-6891-5p may be helpful in the diagnosis of PC and BTC.

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